HIPAA form instructions

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DISABILITY-HIPAA Authorization For Release of Health Information (For use in California)
This form is used by an individual, living in California, who wants to authorize the use or disclosure of protected health information to Assurant Employee Benefits or Union Security Life Insurance Company of New York. For detailed instructions.

HIPAA Authorization For Release of Protected Health Information

This form is used by an individual who wants to give Assurant Employee Benefits or the prepaid companies authorization to disclose protected health information. For detailed instructions.

HIPAA Authorization For Release of Protected Health Information - California Residents

This form is used by an individual residing in California who wants to give Assurant Employee Benefits or the prepaid companies authorization to disclose protected health information. For detailed instructions.

Medical Underwriting—HIPAA Authorization for Release of Protected Health Information

This authorization is used by an individual who wants to give our Medical Underwriting department permission to obtain, use or disclose their protected health information. For detailed instructions.

Instructions and Helpful Hints for Completing the HIPAA Authorization for Release of Protected Health Information

This form contains helpful hints and instructions for completing the HIPAA Authorization for Release of Health Information form.

Request for Accounting of Disclosures of Protected Health Information

This form is used by an individual who wants to request a list of disclosures of his/her protected health information above and beyond the disclosures allowed by law.

Request for Confidential and/or Alternative Communications of Protected Health Information

This form is used by an individual who wants Assurant Employee Benefits or the prepaid companies to communicate with him/her using an alternative means or at an alternative location.

Request for Restrictions on the Use and Disclosure of Protected Health Information

This form is used by an individual who wants to request a restriction on the use and disclosure of his/her protected health information.

Request to Access, Inspect or Copy Protected Health Information

This form is used by an individual who wants to access, inspect, or copy the protected health information that Assurant Employee Benefits or the prepaid companies has about the individual in a designated record set.

Request to Amend or Correct Protected Health Information

This form is us used by an individual who needs to amend or correct his/her protected health information that is created or maintained by Assurant Employee Benefits or the Prepaid companies.

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