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Behavioral Health

HIPAA Forms

• Acknowledgement of Receipt of Notice of Privacy Practices
  (HTML) (Microsoft Word*) (Adobe PDF*)
• Consent for Purposes of Treatment, Payment and Healthcare Operations
  (HTML) (Microsoft Word*) (Adobe PDF*)   
• DDPC’s Confidentiality Agreement Form 890 (Microsoft Word*) (Adobe PDF*)
• HIPAA Rule Governing
  45 CFR 164.502   Authorization to Release Information
  (Microsoft Word*) (Adobe PDF*)
• Notice of Privacy Practices
  (HTML)
  (Microsoft Word*) (Adobe PDF*)

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*For a free viewer or to request a hard copy

 

 

State of Maine Hospitals/Facilities

• Dorothea Dix Psychiatric Center
• Elizabeth Levinson Center (ELC)
• Riverview Psychiatric Center

Administration

• Central Administration
• Region I
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• Notice of Privacy Practices
• Personnel Complaints Policy

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