The Department of Human Services has designed the following new forms to facilitate compliance with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA). Clients may use some of these forms to exercise their rights under this law. Department staff use some of these forms to fulfill their responsibilities.
Clients may print and complete applicable forms and mail them to the Privacy Officer, Department of Human Services, 1305 East Walnut, Des Moines, Iowa 50319-0114, or take them to their worker at any of the Department's locations in the field or in the facilities.
Designation of Personal Representative, Form 470-3948. Clients may use Form 470-3948 when there is a need to designate a personal representative. A "personal representative" is someone designated by another as standing in the other's place or representing the other's interest for one or more purposes.
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