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An Individual's Rights under HIPAA

An Individual's Rights under HIPAA

  • Access to Records Request
    This records request form concerns records maintained by Medicaid, other medical assistance programs, state facilities, and any other component of MDHHS that is subject to the HIPAA privacy regulations.
  • Request for Amendment of Health Record
    This form may be used to request an amendment of your health record if maintained by Medicaid, other medical assistance programs, state facilities, and any other component of MDHHS that is subject to the HIPAA privacy regulations.
  • Accounting of Disclosures Request
    This list request form concerns records maintained by Medicaid, other medical assistance programs, state facilities, and any other component of MDHHS that is subject to the HIPAA privacy regulations. NOTE: See limitations on form.
  • DCH-1230, HIPAA Privacy Complaint
    A privacy complaint filed with this form is appropriate for records maintained by Medicaid, other medical assistance programs, state facilities, and any other component of MDHHS that is subject to the HIPAA privacy regulations.
  • Confidential Communications Request
    This request form concerns records maintained by Medicaid, other medical assistance programs, state facilities, and any other component of MDHHS that is subject to the HIPAA privacy regulations. NOTE: See limitations on form.
  • Request for Restriction of Use and Disclosure
    This records request form concerns records maintained by Medicaid, other medical assistance programs, state facilities, and any other component of MDHHS that is subject to the HIPAA privacy regulations. NOTE: See limitations on form