Manage Private Information Forms

PDF  HIPAA - Request to Represent a Deceased Member

Use this form to designate someone as a representative for a deceased member’s private information. ID: 32260

PDF  HIPAA - Request to Terminate Personal Representative

Use this form to request termination of a representative that exists or was created for a member. ID: 8072A

PDF  HIPAA Request for Appointment of Personal Representative

Use this form to designate someone as a representative for a member’s private information. ID: 8070A