To request data regarding Medicaid programs, please complete the following forms:
| Data Request Form | DOCX | 112.60 KB | 13 Dec, 2019 |
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| DHCF_Data_Request_Form | PDF | 640.41 KB | 21 Jul, 2020 |
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If you are requesting information about a specific consumer, please have the individual complete and sign the authorization form below.
| Autorización para la Divulgación de Información de Salud Protegida | PDF | 84.10 KB | 17 Nov, 2016 |
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| Personal Health Information Release Authorization 9-12-17 | PDF | 728.70 KB | 12 Sep, 2017 |
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