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Get and Sign Instructions Restrict 2003-2022 Form
Restricted must be stated.
4.
Document health information to be restricted.
5.
Document mailing address.
MQD staff:
1.
Verify identity of requestor.
2.
Route original copy of DHS 8028 to MQD Administration.
3.
Log restriction in MQD correspondence database.
4.
Fill out lower half of DHS 8028 with determination.
5.
Document the date of response to the request.
6.
Review check box for appropriate action:
Check box 1. Inform the requestor MQD shall restrict the disclosure...
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