× The federal government has shut down due to the failures of the President and Congress to continue government funding. Millions of Californians receiving benefits from state programs may be impacted. For now, California’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) will continue to provide services and enroll eligible families as long as funding is available. No new federal funding to California WIC will be provided until the President and Congress take action. Families should continue to use their WIC benefits and attend their WIC appointments. This information is subject to change, so please monitor the California WIC website for updates.

Please be wary of potential highly partisan political messaging while visiting federal government websites for information related to the federal government shutdown.

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office of legal services-privacy hipAA forms

Privacy-HIPAA Forms

CDPH 6234 (PDF) - Request for Confidential Communication

CDPH 6235 (PDF) - Request for Confidential Communication of Personal Information by Parent, Guardian or Personal Representative

CDPH 6236 (PDF) - Request for Access to Personal Information

CDPH 6237 (PDF) - Request to Access Personal Information by Parent, Guardian or Personal Representative

CDPH 6238 (PDF) - Request to Amend Personal Information

CDPH 6239 (PDF) - Request to Amend Personal Information by Parent, Guardian or Personal Representative

CDPH 6240 (PDF) - Request to Restrict Use and Disclosure of Personal Information

CDPH 6241 (PDF) - Request to Restrict Use and Disclosure of Personal Information by Parent, Guardian or Personal Representative

CDPH 6242 (PDF) - Privacy/HIPAA Complaint Form

CDPH 6244 (PDF) - Request for an Accounting of Disclosures of Personal Information

CDPH 6245 (PDF) - Request for an Accounting of Disclosures of Personal Information by Parent, Guardian or Personal Representative

CDPH 6247 (PDF) - Authorization for Use and Disclosure of Personal Information

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