WV.gov

An Official West Virginia Government Website

WV.gov

State Agency Directory | Online Services | Phone Directory

HIPAA Forms

Authorization or Revocation to Use and/or Disclose Protected Health Information
Authorization or Revocation to Use and/or Disclose Protected Health Information (Fillable Form)
Request for Access to Protected Health Information
Request for Access to Protected Health Information (Fillable Form)

Department of Human Services - Bureau for Medical Services

350 Capitol Street
Room 251
Charleston, WV 25301
United States