Dhhs Form 505 PDF Details

The Department of Health and Human Services (DHHS) Form 505 was created to help organizations comply with the HIPAA Privacy Rule. The form is used to request protected health information (PHI) from a covered entity. The DHHS Form 505 should be completed by the individual or organization requesting PHI, and must include the reason for the request and the specific information that is needed. Completed forms can be sent to the covered entity by mail, fax, or email.

Form NameDhhs Form 505
Form Length6 pages
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesFM 505 sc dept of health and human services form 505

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