HIPAA – Release of Information Authorization Form
Collected Information
We collect personal information such as names, phone numbers, email addresses, etc., only when voluntarily submitted by our visitors. The information you provide is only used to fulfill your particular request unless you give us permission to use it in another manner.
Shared Information
We may share information with government agencies or any other companies assisting us in fraud prevention or investigation. We may do so when permitted or required by law or when investigating fraud that has already taken place. We also may use other businesses to perform certain services for us, such as maintaining our site and our email services and processing inquiries. We may provide personal information to those businesses when that information is necessary for them to complete a requested transaction or otherwise perform their duties. We will not sell or share your personal information with any unaffiliated third parties for marketing purposes.
Collective Data
Occasionally, we may collect statistical and non-personal information about the use of the site. This information may include how many visitors visit a specific page on the site, how long they stay there, and which hyperlinks they visit. We collect this information to determine which areas of the site are most popular and where to enhance the site for our visitors. This collective data may be used to describe the use of our site to third parties or in response to a government request. However, this data will not personally identify you or any other of our website visitors.
Links to Other Sites
While visiting our site, it is possible that you could be directed (via hyperlink or other means) to other sites that are outside of our control. These other websites may send their own cookies to visitors, collect data, or solicit your personal information. It is important that you read the privacy policies of these other sites before using them. We are not responsible for the privacy practices of other websites and cannot guarantee the security of any personal information that is collected on those other sites.
Contact Us
We reserve the right to make changes to our privacy policy. Any changes to this privacy policy will be posted here. If you have any questions or concerns about our Privacy Policy, please contact us
In compliance with federal and state law, the release of information for any person 18 years or older (including the information regarding a spouse or adult child), must first be authorized. Authorization includes the signature of the individual authorizing the release of their information. Information will not be available to anyone other than the covered patient (i.e. a member, a spouse, or any dependent age 18 or older) without first having this Release of Information Authorization on file. For example, if a subscriber calls about the status for a claim on a 19-year old dependent, that information will not be given to the subscriber without the written consent of the dependent. The same situation holds true for spouse-to-spouse information. However, parents do have a right to information on children under the age of 18 without the child’s consent.
