Application for child support services
The HIPAA Authorization and Privacy Notice is needed by the Division of Child Support Services (DCSS) in all cases where:
- Genetic testing is necessary, and
- When the applicant, child(ren) or noncustodial parent later become disabled and the disability may affect the enforcement of the case.
Please sign these forms and send them with your new application to DCSS. By doing so, you are authorizing disclosure of the protected health information that is deemed necessary by the attorney representing DCSS. The attorney will use this authorization for the following:
- To establish that you are a biological parent or custodian of the child(ren) for whom child support services have been requested;
- To determine the existence of special medical needs of the child(ren) demonstrating a need for additional medical support or specialized health or education services;
- To allow DCSS to release the genetic testing results of either yourself, the opposing party or the child(ren);
- To establish a full or partial disability preventing or limiting your employment, and
- To respond to an order of any court having jurisdiction over any child support action brought on the child(ren)'s behalf.
Please be advised that if you refuse to sign the HIPAA Authorization and Privacy Notice, you will not receive a complete copy of the genetic test results.
Last Revised: 5/10/2019
Attn: DCSS Policy & Paternity Unit