We value your privacy
The Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification provisions were enacted by Congress to establish standards for privacy, security of individually identifiable health information, and electronic transfer of information.
View the forms below to find out more information:
- HIPAA Notice of Privacy Practices / Notificación de las prácticas de privacidad de HIPAA
- Authorization for Release of Protected Health Information / Autorización para divulgar información protegida de salud
- Privacy Complaint form / Formulario de denuncia por violación de privacidad
- Request to Amend or Change PHI / Solicitud para enmendar o cambiar la PHI
- Request for Confidential Communications / Solicitud de Comunicaciones Confidenciales
- Request to Inspect or Receive a Copy of Protected Health Information / Solicitud para Inspeccionar o Recibir copia de Información de Salud Protegida
- Request to Receive an Accounting of Disclosures / Solicitud para recibir un informe de divulgaciones
- Restriction Request Form / Formulario para solicitar restricciones
If you have any privacy concerns, questions, or complaints, you may contact the Fund’s Privacy Officer by telephone at (630) 236-5100 or toll free at (800) 841-3380.
