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Forms for PHI from an Insurance Provider

Aetna Authorization to Release PHI

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Anthem- Blue Cross Authorization to Release Records to 3rd Party

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BCBS of Illinois- Authorization to Release PHI

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BCBS of Minnesota- Authorization to Release PHI

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BCBS- Blue Care Network of MI- Member Consent for Release of PHI

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Cigna Healthcare Authorization for Disclosure of PHI

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CMS Authorization to Release Health Information- Medicare- Form

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Employee Health Insurance Management- EHIM- Authorization to Release PHI

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General Insurance Authorization Form

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General Insurance-PIP Authorization Form

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HAP- Health Alliance Plan Authorization to Release Health Information

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Humana- Authorization for Release of PHI

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McLaren Health Plan- Authorization for Use & Disclosure of PHI

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Meridian Health Plan- Medicaid HIPAA Authorization to Disclose PHI

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MESSA Authorization to Disclose PHI

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Molina Healthcare Authorization for Use & Disclosure of PHI

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Optum- Healthcare Authorization for Release of PHI

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Physicians Health Plan- Authorization for Use-Disclosure of PHI

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Priority Health- Authorization for Release PHI

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State of MI- MDHHS Authorization to Release PHI- Medicaid & MDHHS Records

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United Healthcare- Authorization to Release PHI

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