Medicare Privacy Authorization Forms
A valid privacy authorization form is now available on the
Medicare website for individual beneficiary use. The form meets
the requirements of the Health Insurance Portability and Accountability
Act (HIPAA). Disclosure of personal medical information to
anyone other than the beneficiary will require a signed authorization
form. This authorization form is valid until the beneficiary
revokes it in writing.
Release of personal medical information for HIV requires a
separate authorization form to be signed by the beneficiary.
This authorization form is valid for one hundred and eighty
days (180) from the effective date or until the beneficiary
revokes it in writing.
If you have any questions about the authorization form you
can contact the Medicare Customer Service Dept. at 1.877.602.7909.
General
Privacy Authorization Form
HIV Privacy
Authorization Form |
