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The Utah Department of Health, Division of Medicaid and Health Financing, is committed to protecting medical information. The Division is required by law to maintain privacy of any personal health information and to provide a client privacy notice. Standard request forms have been created for release of personal health information.

Notice of Privacy Practices
Medicaid English
Medicaid Español

Notice of Privacy Practices for Medicaid Providers
SB20 Requirements

Request Forms
Authorization to Disclose Health Information (for agency to disclose)
Authorization to Disclose Health Information (for disclosure to agency)
Client Request for Personal Health Information