Privacy Forms

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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.

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For additional forms, concerning your medical information please visit the Orange County Health Care Agency Custodian of Records webpage.

For more information send us an email or call (714) 568-5614.