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hipaa form
HIPAA Privacy Act Form
Dec 7, 2004 5:00 PM
Federal Law prevents SHIP from speaking to another person about your medical information and claims.
A SHIP member should only sign the authorization form and submit it, if he/she wants another party to act on his/her behalf. If this is not an immediate need, then carefully tuck away the form for the future when circumstances may change.
Remember, if you fill out the form, in the event that you become incapacitated and are unable to file claims, etc., we would then be allowed to speak/correspond with the person(s) you designate.
Click here to view a sample of how the form should be completed.
