CA CDCR 7385 2009 free printable template
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STATE OF CALIFORNIACALIFORNIA DEPARTMENT OF CORRECTIONS AND REHABILITATION Attachment C AUTHORIZATION FOR RELEASE OF INFORMATION CDCR 7385 Rev. 05/09 Page 1 of 2 YOUR INFORMATION First Name Middle Name Last Name Street Address City/State/Zip Date of Birth CDCR/YA Person/Organization Providing the Information California Prison Health Care Services Name Address Phone Fax number 45 C.
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How to fill out CA CDCR 7385
How to fill out CA CDCR 7385
01
Obtain the CA CDCR 7385 form from the California Department of Corrections and Rehabilitation website or your correctional facility.
02
Fill out the personal information section, including your name, inmate number, and facility name.
03
Provide detailed information regarding your medical history and current medical needs in the designated sections.
04
If applicable, include information about any medications you are currently taking.
05
Ensure all sections are completed accurately and legibly.
06
Review your filled-out form for any missing information or errors.
07
Submit the completed form to the appropriate department or individual as instructed, ensuring you keep a copy for your records.
Who needs CA CDCR 7385?
01
The CA CDCR 7385 form is required for inmates within the California correctional system who need to document their medical history or request medical services.
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People Also Ask about
What is a 7385 form?
CDCR 7385, Authorization for Release of Protected Health Information.
How do I get my medical records from Cdcr?
To request review or release of your CDCR health care records or information, you should complete a CDCR Form 7385 (Authorization for Release of Protected Health Information). A copy of the 7385 form is attached to this letter. You should do your best to fill out all sections of the 7385 form.
What is the Cdcr authorization for release of information?
(a) Patients may authorize the release of their health care information by completing the CDCR 7385, Authorization for Release of Protected Health Information, to allow a family member or friend to request and receive an update when there is a significant change in the patient's health care condition.
What is an authorization for release of information?
Authorization for release of information means the form prescribed by the agency for the purpose of authorizing the release of a confidential record, signed and dated by the person empowered to release the information.
What is the definition of authorization to release medical information?
Generally, an authorization provides the authority for a doctor's release of PHI for specified purposes, which are generally other than treatment, payment, or healthcare operations, or, to disclose protected health information to a third party specified by the individual.
How much can you charge for medical records in California?
Can a doctor charge me for copies of my medical records or x-rays? Yes, pursuant to Health & Safety Code section 123110, a doctor can charge 25 cents per page plus a reasonable clerical fee.
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What is CA CDCR 7385?
CA CDCR 7385 is a form used by the California Department of Corrections and Rehabilitation (CDCR) to report various information related to inmates and their healthcare status.
Who is required to file CA CDCR 7385?
Individuals and institutions involved in the care and management of inmates, including healthcare providers and correctional facilities, are required to file CA CDCR 7385.
How to fill out CA CDCR 7385?
To fill out CA CDCR 7385, you must complete the form by providing necessary inmate information, including their identification details, diagnosis, treatment plans, and any other relevant healthcare data.
What is the purpose of CA CDCR 7385?
The purpose of CA CDCR 7385 is to ensure that the healthcare needs of inmates are accurately documented and monitored, facilitating appropriate medical care and compliance with state regulations.
What information must be reported on CA CDCR 7385?
Information that must be reported on CA CDCR 7385 includes the inmate's personal details, medical history, current health status, treatment received, and any planned future healthcare interventions.
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