HIRSP Policyholders

Privacy Practices and Forms

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

This notice does not affect your benefits or eligibility.
Effective Date: April 14, 2003

HIRSP Notice of Privacy Practices

All Other Privacy Forms

Your Right to an Independent Review
HIPAA Privacy Authorization for Use or Disclosure Form
HIPAA Privacy Revocation of Authorization Form
HIPAA Privacy Restriction Request Form
HIPAA Privacy Access Request Form
HIPAA Privacy Accounting Request Form
HIPAA Privacy Alternative Communication Request Form
HIPAA Privacy Amendment Request Form
HIPAA Privacy Complaint Form