offered by
related to

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.

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