dhcf

Department of Health Care Finance - DHCF

Public Notice: Attention Medicaid Providers- The web portal www.dc-medicaid.com has been decommissioned. The new provider portal is https://medicaid.dc.gov. Questions/Issues? Provider Contact Center at 866-752-9233.

^-A ⁺A

Listen

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

DC Agency Top Menu

Search form

Department of Health Care Finance - DHCF

Authorization for Use and Disclosure of Private/Protected Health Information

DC Agency Top Menu

document.write(document.getElementById("site-slogan").innerHTML);

Authorization for Use and Disclosure of Private/Protected Health Information