Health Insurance Portability & Accountability Act
Notice of Privacy Practices
The Notice of Privacy Practices explains how medical information about our members may be used and disclosed and how our members can get access to such information. Additionally, the notice describes our member's rights and details our legal duties with respect to protected health information.
This form is to be used to obtain an authorization from a member or a member's personal representative to disclose the member's health information to an individual or organization outside of Highmark. This form is used when the information is being disclosed for purposes other than treatment, payment or health care operations; when psychotherapy, HIV, mental health or substance abuse information is being disclosed; or when written documentation is needed to show that a member has authorized another to receive specific information about them.