The privacy of an individual's health information is protected by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"). HIPAA limits the ability for Midlands Choice to disclose health information, unless the disclosure is permitted by the law or unless you request or authorize the disclosure.

Patient/Insured Authorization to Allow Midlands Choice to Communicate with a Third Party about Health Information

If you would like to permit Midlands Choice to speak with another person, such as a family member, about your health information, print, complete, and return this Authorization Form to Midlands Choice.

Patient/Insured Request for a Copy of Health Information

If you would like to obtain a copy of your health information or have a copy of your health information directed to a third party, please print, complete, and return the Request For Access Form to Midlands Choice.