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
*Confidential Information Release Forms alone do not grant authorization to your representative to file appeals on your behalf. If you wish to have someone request an appeal on your behalf please submit a completed Confidential Information Release Form along with either an Authorized Representative Designation Form or Healthcare Power of Attorney. For more information on which form to use, visit the “What Form Should I Use?” tab to the right.
