Release of Personal Health Information
Federal
privacy requirements enacted under the Health Information Portability and
Accountability Act (HIPAA) restrict the release of personal health
information. In order for information on any HealthChoice
participant (member, spouse or dependent age 18 or over) to be released to
anyone other than themselves, an Authorization to Disclose Health
Information form must be completed and returned to the address on
the form. In the event that the participant wishes to change or
revoke the authorization, a Revocation form is required.
To access a printable copy of the Authorization to Disclose
Health Information form or the Revocation form, select the Site Map option
in the menu at left and then select from the Forms & Applications section.
Please call HealthChoice Member Services at 1-800-752-9475
to have a form mailed to you.
