- 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
Contact for GIC HIPAA Privacy Forms
Online
Recommended
GIC online contact form
Phone
M-F 8:45 a.m.-5 p.m.
Fax
Operations
Fiscal
(617) 367-9874
Address
Street Address
John W. McCormack Building, 1 Ashburton Place, Suite 1413, Boston, MA 02108