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

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