Forms

Mental Health Parity Disclosure Request Form

Your Rights and Protections Against Surprise Medical Bills

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