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STATE OF CALIFORNIA-HEALTH AND HUMAN SERVICES AGENCY Department of Health Care Services PRIVACY OFFICE CONFIDENTIAL COMMUNICATION REQUEST File Number: You may request the Department of Health Care
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How to fill out a confidential communications request DHCS:

01
Download the confidential communications request DHCS form from the official DHCS website or obtain it from your healthcare provider.
02
Fill out your personal information accurately, including your full name, contact information, and date of birth.
03
Indicate the specific information you wish to keep confidential by checking the appropriate boxes on the form. This could include medical records, test results, or any other sensitive information.
04
Provide a detailed explanation as to why you are requesting confidential communication. This can help the healthcare provider understand your specific needs and ensure your request is appropriately addressed.
05
Sign and date the form to validate your request. Make sure to read and understand any additional instructions or disclosures provided on the form.

Who needs a confidential communications request DHCS:

01
Individuals who require their medical or sensitive information to be kept confidential due to safety concerns or potential harm if disclosed.
02
Patients who wish to maintain privacy and control over their medical records and related information.
03
Anyone who wants their healthcare provider to communicate with them in a specific manner, such as via email, phone, or a designated address, to ensure confidentiality is upheld.
Remember, the specific reasons for needing a confidential communications request DHCS may vary from person to person, but it is crucial to fulfill the request accurately and provide all necessary information for it to be processed effectively.
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Confidential communications request DHCS is a form used to request that all communications from the Department of Health Care Services (DHCS) be sent to an alternate address or by alternate means.
Any individual or organization that wishes to keep their communications with DHCS confidential is required to file a confidential communications request.
To fill out the confidential communications request DHCS form, you must provide your personal information, specify how you would like to receive communications, and sign and date the form.
The purpose of the confidential communications request DHCS is to protect the privacy and confidentiality of individuals or organizations who are interacting with DHCS.
The confidential communications request DHCS form requires information such as the individual or organization's name, contact information, preferred method of communication, and any additional instructions.
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