offered by

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.

Table of Contents

Authorized Representative Designation Form

MassHealth - Notice of Privacy Practices

Permission to Share Information Form

Feedback

Did you find what you were looking for on this webpage? * required
We use your feedback to help us improve this site but we are not able to respond directly. Please do not include personal or contact information. If you need a response, please locate the contact information elsewhere on this page or in the footer.
We use your feedback to help us improve this site but we are not able to respond directly. Please do not include personal or contact information. If you need a response, please locate the contact information elsewhere on this page or in the footer.

If you need to report child abuse, any other kind of abuse, or need urgent assistance, please click here.

Feedback