Confidentiality and Privacy

Unless required by law, Community Health Plan will not release personal health or identifying information to anyone – including a family member or employer – without the appropriate written consent from you.

If you would like to authorize a representative to speak on your behalf (or on behalf of your covered child), please complete the HIPAA Authorization Form. This form requires the following information:

• Member's full name
• Member's date of birth
• Member's current address
• Name of the individual or institution to receive the information
• Current date
• Signature of the member or of his/her legal guardian

Once you've completed this form, please return to Community Health Plan.