Privacy Forms

For more information send us an email or phone 619-338-2808.

Click on the link below to download the file you need.

Privacy Incident Reporting Form – This form is to be used by County and Contractor staff to report suspected and actual privacy incidents to the HHSA Privacy Officer.

Authorization to Use or Disclose Protected Health Information (PHI) - This authorization form may be used by you as a patient/client of the County in order to initiate a request to have PHI about you disclosed outside of the Health and Human Services Agency or between Programs with sensitive confidentiality requirements.

 

For more information send us an email or phone 619-338-2808.