Virginia 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 |