DHS 35: Forms
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DHS 35: Forms
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Client Rights & Confidentiality
Client Rights Form (available soon)
Client Rights Sample Document (available soon)
Joint Notice of Privacy Practices – English (also under FORMS)
Business Associate Agreement form - includes new HITECH ACT requirements, provided by HIPAA Collaborative of Wisconsin
HIPAA Collaborative of Wisconsin - Hipaacow.org - is an important resource for information on federal HIPAA laws. It is a non-profit organization providing up-to-date information and useful forms for entities covered by HIPAA regulations. (also under Other Resources tab)
DHS - Client Rights Office (CRO) - review thoroughly; this page contains a lot of information including links to:
Community Grievance Decision Digest - which links to a page that contains summaries of relevant laws and decisions made via the State Grievance Examiner in the CRO and the Administrator of the DMHSAS
DMHSAS - Consent & Privacy forms (also under DHS Resources)
F-22538 – PDF – Consent to Film or Tape
F-22538 – Word – Consent to Film or Tape
F-22538S – PDF – Consent to Film or Tape - Spanish
F-24277 BRD – PDF - Informed Consents for Medications: Brand Name Index
F-24277 GEN – PDF - Informed Consents for Medications: Generic Name Index
F-26003 – PDF – Notice of Privacy Practices - Treatment Facilities
F-26030 – Word – Notice of Privacy Practices - Treatment Facilities
F-26003H- PDF – Notice of Privacy Practices - Treatment Facilities - Hmong
F-26003S – PDF – Notice of Privacy Practices - Treatment Facilities - Spanish
F-26100 – PDF – Clients Rights Limitation or Denial Documentation
HFS - Consent to Treat forms (also under DHS Resources)
F-82009 – PDF – Confidential Information Release Authorization (consent to treat)
F-82009 – Word – Confidential Information Release Authorization (consent to treat)
Several Versions exist of this Form. Visit HFS forms page for more information.
