Request for Access to PHI (1)

Request for Review of Denial of Access to PHI (3)

Request Form for Accounting of Disclosures of PHI (5)

Request to Make Amendments to PHI (9)

Authorization to Release Medical Information (12)

Request for Attachment of Documentation to future PHI (14)

Clients Statement of Disagreement with a Denial of Amendment of PHI (15)

Revocation of Authorization for the Use or Disclosure of PHI (16)

Privacy Complaint Form (18)

Notice of Privacy Practices (23)

Patient Acknowledgement and Consent Form (24)

Request for Additional Restrictions on the Use and Disclosure of PHI by Individuals (26)

Confidential Communication Request Form (27)

Request to Opt Out of TCHD Fundraising Communication (31)