HIPAA Authorization Form


As you are aware, we cannot work with PHI (protected health information) without approval from the
employee. When an employee approaches us with a claim problem, we will be asking them to complete
the form below before we can make calls on their behalf.

We anticipate that health carriers will be providing their own form, but in the absence of that, please use
our version.

 

Authorization to Access and Release Form

 

You must have Adobe Acrobat Reader to view and print the form.  If you do not have Adobe Acrobat   Reader, you can download it FREE by clicking the link below.