Forms for PHI from an Insurance Provider

Aetna - Authorization to Release PHI (Dec 2017)

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Aetna - Authorization to Release PHI (Oct 2016)

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AFLAC - Authorization to Release Information

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Anthem Blue Cross - Authorization to Release PHI (March 2012)

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Anthem Blue Cross - Authorization to Release Records to a 3rd Party (2022)

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BCBS - Blue Care Network Member Consent for Release of PHI (Sep 2016)

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Golden Rule Insurance Company - Authorization for Disclosure of Personal Information (Feb 2018)

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Health Alliance Plan - Authorization to Release PHI (Dec 2015)

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McLaren - Authorization for Release of PHI (April 2015)

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McLaren Health Plan - Authorization for Use & Disclosure of PHI (Aug 2017)

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McLaren Lapeer - Authorization to Release PHI

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McLaren Oakland - Authorization to Release PHI

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McLaren Port Huron - Authorization to Release PHI

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MESSA - Authorization to Release PHI (July 2017)

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Priority Health - Authorization for Release of Personal and Health Information (Sep 2015)

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