Advance Directives and Other Legal Documents

All states have laws that allow individuals to make future healthcare treatment decisions, in the event they are unable to make or communicate their own decisions later. This enables your family and doctors to understand the type of medical care you want or do not want. State laws also allow you to appoint a person to make future healthcare treatment decisions for you if you are unable to make them. The documents related to these laws are called “advance directives.” Learn more about these legal documents:

Advance Directive Notice
AZ Blue has partnered with Five Wishes, which is a tool that may be helpful when thinking about documenting your healthcare choices. Find more information on the videos linked below:

Five Wishes Preview video
Five Wishes Waiting Room video

Authorization to Act on a Members Behalf - This form allows a representative to act for the member on appeals, grievances, and coverage determinations. This form includes access to and use of protected health information (PHI).

AOR Form – English
AOR Form – Español

Information Only Authorization - This form allows a member to give a representative permission to receive information about benefits, care, claims, appeals, and prior authorizations. No decisions or actions can be taken with this form.

Confidential Information Release (CIR) Form - English          Online Form Link
Confidential Information Release (CIR) Form - Español
Confidential Information Release for HIV related - English
Confidential Information Release For HIV related - Español 

AZ Blue is committed to complying with these state laws and with the federal law regarding the distribution of advance directive information to our members upon enrollment. We cannot refuse care or discriminate against you based on whether or not you have completed an advance directive. We educate our staff about advance directive rights and procedures and offer community education on these rights. AZ Blue documents whether or not members have advance directives in a prominent part of their current medical records. Learn more in Chapter 8, “Your rights and responsibilities,” in your plan Evidence of Coverage (EOC).