GIC HIPAA Privacy Forms

Forms to enroll in and change your GIC health and other benefit coverage options

• HIPAA Notice of Privacy Practices - Comprehensive list of GIC enrollee privacy rights.
• HIPAA Amendment Form - For asking the GIC to amend erroneous or incomplete protected health information created and maintained by the GIC.
• HIPAA Confidential Communication Form - For personal safety reasons, form to request alternative GIC communication delivery.
• HIPAA Inspect and Copy Form - For requesting a copy of protected health information created and maintained by the GIC.
• HIPAA Privacy Complaint Form - For lodging a complaint with the GIC on how the GIC handled your protected health information.
• HIPAA Accounting of Protected Health Information Disclosure Form - For requesting an accounting of the GIC's disclosures of protected health information on or after April 14, 2003.
• HIPAA Authorization for Release of Health Information Form - For authorizing GIC representatives to disclose or receive your protected health information with persons you designate.
• HIPAA Restrict Access Form - For requesting to restrict the GIC's use or disclosure of protected health information.
• HIPPA Information Release Form