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BlueChoice - Protected Health Information (PHI) Forms


Notes

  1. Viewing and printing these documents requires Adobe Acrobat.
  2. If you do not already have this program, you can download it free from the Adobe site.

Instructions

Download Single Form: Use the grid below to download and print a form*.

Ordering Multiple Copies: Please contact your CareFirst Sales Representative.


Form
 
Information Release Authorization
 view form
Information Release or Personal Representative Revocation
 view form

Adobe Acrobat PDF Viewing and printing this document requires Adobe Acrobat Reader, which can be downloaded free from the Adobe site.

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