Confidentiality/Privacy of Protected Health Information (PHI): 03-01

Attachments:
A. Declaration of Notice of Confidentiality

B. Authorization for Use or Disclosure of Health Information (Mental Health): English | Spanish | Chinese | Tagalog | Tongan | Russian

C. Authorization for the Verbal Release of Client Information (Mental Health):  English | Spanish | Chinese | Russian | Tagalog | Tongan

D. Excerpts from W&I Code |

E. Privacy Complaint Form

F. Exchange of Information: Principles and Definitions

G. Exchange of Information: Guide to Sharing

H. Authorization for Use or Disclosure of Protected Health Information (AOD Services): English | Spanish | Chinese | Russian | Tagalog | Tongan

Original policy date: 2/25/03

3/13/13; Technical Edits 1/23/14; amended 5/15/20, 11/17/23
Translations of Attachments added 9/26/16
Attachments B & C (English): updated 5/15/20, Technical Edits 6/23/20
Attachment H (English): Technical Edit 7/1/20