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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 Request 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.

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.

Authorization Form for Release of Health Information - For authorizing GIC representatives to disclose or receive your protected health information with persons you designate.

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

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