Change Healthcare notifying individuals of data breach. Learn more here.
Maryland Group Applications and Forms
A variety of applications and other forms are available.
Please contact your Account Manager or Broker Representative to ensure that you have the correct forms. Please choose from the list below:
Authorization Form for Information Release |
Personal Representative Form |
Revocation Authorization Personal Representative Designation |
Access to PHI Form |
Accounting of Disclosures |
Amendment to PHI Form |
Restrict PHI Form |
Terminate Restriction to PHI Form |
Request for Confidential Communications Form This form should be returned to: CareFirst BlueCross BlueShield |