These printable forms allow you to exercise your privacy rights in the most efficient manner. By printing, completing and sending these forms to the Privacy Office, your request will be processed efficiently because we will have the information needed
to fulfill the request.
- Authorization for Release
You have the right to authorize Health Advantage to disclose information regarding claims, payments
or other communications to any person or entity.
- Request for accounting
You have the right to request a listing of any disclosures we have made of your protected health information
for purposes other than payment or healthcare operations.
- Request for confidential communication
You have the right to request that we keep communications with you confidential and communicate in
an alternate manner.
- Request for restrictions
You have the right to request that we restrict the use of your protected health information for payment
and healthcare operations.
- Request to correct or amend record
You have the right to request that any information we created about you be amended if you believe that
it is incorrect.
- Request to inspect health information
You have the right to inspect or get a copy of records we maintain about you in a designated record
set and which we used to make a decision about you.