Manage Private Information Forms

 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

 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

 HIPAA Request for Appointment of Personal Representative

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