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Member handbook
Forms
- Authorization to Release Protected Health Information (PHI) – English (PDF)
- Authorization to Release Protected Health Information (PHI) – Spanish (PDF)
- Authorization to Release Psychotherapy Notes – English (PDF)
- Authorization to Release Psychotherapy Notes – Spanish (PDF)
- Protected Health Information (PHI) Access Request – English (PDF)
- Protected Health Information (PHI) Access Request – Spanish (PDF)
- Request for an Accounting of Disclosures of Protected Health Information (PHI) – English (PDF)
- Request for an Accounting of Disclosures of Protected Health Information (PHI) – Spanish (PDF)
- Removal of Authorization Previously Given – English (PDF)
- Removal of Authorization Previously Given – Spanish (PDF)
- Fraud, waste and abuse form