General Forms:

Confidential Communications Request Form

Accounting of Non-Authorized Use or Disclosure Request Form

Privacy Complaint Form

Authorization Forms:

Medical Provider Authorization Forms

Aetna US Healthcare Authorization Form

Blue Cross Authorization Form (English)

Blue Cross Authorization Form (Spanish)

CaliforniaCare Authorization Form

Kaiser Mid-Atlantic Authorization Form

Kaiser Northern California Authorization Form

Kaiser Southern California Authorization Form

Lovelace (New Mexico) Authorization Form

MAMSI/MDIPA Authorization Form

UnitedHealthcare (Colorado) (Formerly PacifiCare) Authorization Form

UnitedHealthcare (Arizona) (Formerly PacifiCare) Authorization Form

Dental Provider Authorization Form

Safeguard Dental Authorization

Medical Provider Authorization Revocation Forms

Blue Cross Authorization Revocation Form

California Care Authorization Revocation Form