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Immunizations Family Planning WIC BCCCP

Immunizations

Clinics are held every Tuesday and Thursday by appointment. Late clinics are held on Tuesdays of each month by appointment.

Family Planning

The program is open to all women and men of childbearing age.

WIC

This program offers nutrition education and benefits.

Breast and Cervical Cancer Control Program

Residing in our service area of Bay, Huron, Saginaw, Sanilac, St. Clair, and Tuscola Counties.

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Bad Axe, MI
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HIPAA FORMS

    Attachment 1
       Request for Access to Protected Health Information.
    Attachment 3
       Request for Review of Denial of Access to Protected Health Information.
    Attachment 5
       Request Form for Accounting of Disclosures of Protected Health Information.
    Attachment 9
       Request to Make Amendments to Protected Health Information
    Attachment 12
       Authorization to Release Medical Information.
    Attachment 14
       Request for Attachment of Documentation to Future Protected Health Information Release.
    Attachment 15
       Clients Statement of Disagreement with a Denial of Amendment to Protected Health
       Information - Provider Rebuttal.

    Attachment 16
       Revocation of Authorization of an Authorization for Use or Disclosure of Protected Health Information.
    Attachment 18
       Privacy Complaint Form.
    Attachment 23
       Notice of Privacy Statement.
    Attachment 24
       Patient Acknowledgement and Consent Form.
    Attachment 25
       Request for Additional Restrictions on the Use and Disclosure of Protected Health
       Information by Individuals.

    Attachment 26
       Request for Termination of Additional Restrictions on the Use and Disclosure of Protected
       Health Information by Individuals.

    Attachment 27
       Confidential Communications Request Form.
    Attachment 31
       Request to Opt Out of HCHD Fundraising Communication.

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