Get Hipaa Request For Confidential Communications Stanford Benefits Doc #359 - Benefits Stanford

The HIPAA Request For Confidential Communications form allows users to request alternate methods of communication regarding medical and billing information. This guide provides a step-by-step approach to ensure you can successfully complete and submit the form online.

Follow the steps to fill out the form accurately and efficiently.

1. Use the ‘Get Form’ button to access the HIPAA Request For Confidential Communications form and open it for editing.
2. Fill in your name in the designated field to identify yourself.
3. Enter the request date to indicate when the request is being made.
4. Provide your address, as this is essential for communication purposes.
5. Input your phone number to ensure the Group Health Plan can reach you regarding this request.
6. Select the type of request you are making by checking the appropriate box: 'New Request', 'Change to Prior Request', or 'Withdrawal of Prior Request'.
7. Specify the information for which you are requesting confidential treatment in the provided space.
8. Indicate your preferred delivery method by checking the relevant box and providing the necessary address or phone number for communication.
9. If there are alternative instructions for communication, provide those details in the specified section.
10. Sign the form as the participant or personal representative to validate your request.
11. If signing on behalf of the participant, print your name and indicate your relationship to the participant.
12. Complete the internal use section only if required, this section is for the Group Health Plan's use after your submission.
13. Once filled out, save your changes, and choose to download, print, or share the form as needed.

Take action today by completing the HIPAA Request For Confidential Communications form online.