Home
Forms Library
County of Los Angeles, Department of Public Health

County of Los Angeles, Department of Public Health 2026

County of Los Angeles, Department of Public Health Preview on Page 1

See details

4.7 out of 5

52 votes

The document is a release of information form for patients within the Substance Abuse Prevention and Control (SAPC) Provider Network. It allows patients to authorize the sharing of their protected health information among various healthcare providers for the purpose of coordinating care and substance use disorder treatment. The form outlines patient information, entities authorized to share health data, the scope of disclosure, expiration of authorization, and important legal protections regarding confidentiality. It also includes an addendum listing participating SUD providers.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out County of Los Angeles, Department of Public Health with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the County of Los Angeles, Department of Public Health form in the editor.
Begin by filling out your personal information in Section I. Enter your name (Last, First, Middle), date of birth, address, Medi-Cal or My Health LA number, and phone number.
In Section II, choose between Option 1 or Option 2 for sharing health information. If you select Option 2, list the specific providers authorized to share your information.
Proceed to Section III and specify the scope of disclosure. Check all relevant boxes indicating what type of health information can be shared.
In Section IV, indicate the expiration date for this authorization. This can be a specific date or one year from the execution date.
Review Section V for important information regarding your rights and protections under federal regulations before signing in Section VI.
Complete Sections VII and VIII if you wish to revoke authorization or understand prohibitions on redisclosure.

Start using our platform today to easily fill out and manage your health forms online for free!

See more County of Los Angeles, Department of Public Health versions

We've got more versions of the County of Los Angeles, Department of Public Health form. Select the right County of Los Angeles, Department of Public Health version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2025	4 Satisfied (34 Votes)
2025	4.8 Satisfied (31 Votes)
2024	4.3 Satisfied (21 Votes)
2024	4.6 Satisfied (51 Votes)
2024	4.5 Satisfied (23 Votes)
2024	4.8 Satisfied (29 Votes)
2023	4.7 Satisfied (42 Votes)
2023	4.4 Satisfied (48 Votes)
2023	4 Satisfied (63 Votes)
2023	4.5 Satisfied (26 Votes)
2023	4.6 Satisfied (34 Votes)
2023	4.2 Satisfied (30 Votes)
2023	3.9 Satisfied (31 Votes)
2023	4.3 Satisfied (42 Votes)
2023	4.7 Satisfied (39 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Who is in charge of the Department of health?

Robert F. Kennedy, Jr. is the 26th Secretary of the U.S. Department of Health and Human Services.

Who is in charge of the US public health service?

The Surgeon General oversees the U.S. Public Health Service (USPHS) Commissioned Corps, an elite group of over 6,000 uniformed officers who are public health professionals.

How do I file a complaint with the Los Angeles health Department?

Submit Complaint Online. Telephone complaints Environmental Health Customer Call Center at (888) 700-9995 Monday - Friday from 8:00 a.m. - 5:00 p.m., excluding Holidays. Report Foodborne Illness online or call the Morbidity Unit at (213) 240-7821 (Mon-Fri, 8:00 a.m. to 4:30 p.m.).

Who oversees the U.S. healthcare system?

The U.S. Department of Health and Human Services (HHS) comprises multiple operating divisions and agencies within the U.S. Public Health Service and three human services agencies.

Who runs the U.S. Department of health?

Robert F. Kennedy Jr. is the current secretary of health and human services, having held the position since February 13, 2025.

Security and compliance

At DocHub, your data security is our priority. We follow HIPAA, SOC2, GDPR, and other standards, so you can work on your documents with confidence.

Learn more

What does LA County Public Health do?

DPH works to protect and improve the health and well-being of the 10 million residents within the County through a variety of programs, community partnerships, and services. The Director of DPH is Barbara Ferrer, PhD, MPH, MEd.

Who controls the health department?

Before the separate federal Department of Education was created in 1979, it was called the Department of Health, Education, and Welfare (HEW). Washington, D.C. HHS is administered by the secretary of health and human services, who is appointed by the president with the advice and consent of the United States Senate.

What is the biggest health issue in Los Angeles?

The leading cause of premature death in Los Angeles County is coronary heart disease (Figure 6). Air pollution affects heart health and directly impacts other causes of premature death, including lung cancer, stroke, and cancer.

County of Los Angeles, Department of Public Health 2026

Here's how it works

How to use or fill out County of Los Angeles, Department of Public Health with our platform