Protecting your privacy is important to us.
HIPAA – Health Insurance Portability and Accountability Act
This act passed by Congress in 1996 ensures the protection of your health information.
Click here to download a full copy of our HIPAA Notice of Privacy Practices.
Following are links to authorizations that are required before any protected health information can be accessed or released.
If you want us to send your protected health information to a third party (e.g. attorney, other insurance company, or family member):
LS264 10-2003 AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION
If you want us to be able to discuss your protected health information with anyone (e.g. agent, family member):
LS253 11-2010 AUTHORIZATION TO DISCLOSE MEDICAL INFORMATION FOR CUSTOMER SERVICE
If you want copies of your protected health information:
LS257 02-2013 REQUEST FOR PATIENT ACCESS TO HEALTH INFORMATION
If you want to allow us to request your protected health information from a third party:
LU129 01-2010 AUTHORIZATION FOR RELEASE OF HEALTH RELATED INFORMATION