Wichita Kansas Request for Accounting of Disclosures of Protected Health Information

State:
Multi-State
City:
Wichita
Control #:
US-3581
Format:
Word; 
Rich Text
Instant download

Description

This form is used by an individual to request an accounting of the persons or entities to whom the individual's protected health information has been disclosed. Permitted exclusions from the accounting are also described.
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Wichita Kansas Request for Accounting of Disclosures of Protected Health Information