Forms

Instructional PDF for Machine Readable Files
BCBSAZ Machine Readable Files
American Specialty Health Machine Readable Files
Davis Vision Machine Readable Files

Mental Health Parity Disclosure Request Form

Your Rights and Protections Against Surprise Medical Bills
Your Rights and Protections Against Surprise Medical Bills in Spanish

Authorized Representative Designation Form
BCBSAZ Confidential Information Release
BCBSAZ Confidential Information Release in Spanish
BCBSAZ Confidential Information Release - HIV Related Information
BCBSAZ Confidential Information Release - HIV Related in Spanish
HIPAA Notice of Privacy Practices
Optum Pharmacy Confidential Information Release Form