Legal Notices & Privacy Information

Related Documents

PHI Authorization Form Authorize the release of your PHI. PHI Access Request Form Request & inspect a copy of your PHI, maintained by FirstCare. PHI Amendment Request Form Request an amendment to you PHI. PHI Accounting Request See how your PHI was disclosed. Confidential Communication Request Form Request FirstCare communications via alternate means. PHI Restriction Request Form Request use or disclosure restrictions on your PHI. HIPAA Standard Authorization Form (Spanish) HIPAA Formulario de Autorización Estándar. Privacy & Security Complaint Form File a privacy & security complaint with FirstCare Health Plans.