• This page, HIPAA forms for MassHealth Members, is   offered by
  • MassHealth

HIPAA forms for MassHealth Members

Use the forms below to choose an authorized representative, read about our privacy practices, or give MassHealth permission to share your information.

If you need one of the forms in a language other than Spanish (find the Spanish versions on the page below), you can request on here: MassHealth HIPAA  Forms for non-English and Spanish Speakers.


Table of Contents

Authorized Representative Designation Form

MassHealth - Notice of Privacy Practices

Permission to Share Information Form

Help Us Improve Mass.gov  with your feedback

Please do not include personal or contact information.