dhcf

Department of Health Care Finance - DHCF

Attention Medicaid Program Participants: If you received a letter from Wellpoint District of Columbia regarding a data breach, click here to get the latest information.

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Authorization for Use and Disclosure of Private/Protected Health Information

Monday, January 13, 2020

Authorization for Use and Disclosure of Private/Protected Health Information

Attachment(s):

Medical Authorization Form.pdf

Medical Authorization Form (Fillable).pdf

dhcf

Department of Health Care Finance - DHCF

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Department of Health Care Finance - DHCF

Authorization for Use and Disclosure of Private/Protected Health Information

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Authorization for Use and Disclosure of Private/Protected Health Information