CCWHC
Crisis: 330-264-9029
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Home > For Patients > HIPAA > HIPAA Forms

HIPAA Forms

Clients Rights
HIPAA
   HIPAA Forms

          Request for Access to Health Information
          Request for Amendment to Health Information
          Request to Restrict Confidential Communication
          Request to Restrict Use & Disclosure of Health Information
​
          Request to Opt Out of Clinisync Health Information Exchange

For More Information Please Contact:

                       Diane S. DeRue, MPA, LSW
                       Vice President/Chief of Recovery Services
                       Corporate Compliance and Privacy Officer

                       (330) 264-9029
                       dsderue@ccwhc.org


All photographs are compliments of our Counseling Center "family and friends". Enjoy the talent!
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The Counseling Center of Wayne and Holmes Counties
2285 Benden Drive
Wooster, OH 44691
Main Office: (330) 264-9029
Toll Free: (877) 264-9029
Fax: (330) 263-7251 
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