HIPAA Notice of Privacy Practices doc format of hipaa2013noticeofprivacypractices.doc
: Comprehensive list of GIC enrollee privacy rights.

Amendment Request Form pdf format of HIPAAAMENDMENTrequestFORM.pdf
: For asking the GIC to amend erroneous or incomplete protected health information created and maintained by the GIC.

Confidential Communication Form pdf format of HIPAACONFIDENTIALCOMMUNICATIONFORM.pdf
: For personal safety reasons, form to request alternative GIC communication delivery.

Request to Inspect and Copy Form pdf format of HIPAAINSPECTANDCOPYFORM.pdf
: For requesting a copy of protected health information created and maintained by the GIC.

Privacy Complaint Form pdf format of HIPAAprivacyCOMPLAINTFORM.pdf
: For lodging a complaint with the GIC on how the GIC handled your protected health information.

Accounting of Protected Health Information Disclosure Form pdf format of HIPAAprothealthinforequestform.pdf
: For requesting an accounting of the GIC's disclosures of protected health information on or after April 14, 2003.

Authorization Form For Release of Health Information pdf format of HIPAAreleaseofinfoauthorizationFORM.pdf
: For authorizing GIC representatives to disclose or receive your protected health information with persons you designate.

Request to Restrict Access Form pdf format of HIPAAREQUESTTORESTRICTFORM.pdf
: For requesting to restrict the GIC's use or disclosure of protected health information.

This information provided by the Group Insurance Commission .

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