Family Member Access User Guide
|
|
|
- Madlyn O’Neal’
- 8 years ago
- Views:
Transcription
1 Family Member Access User Guide TRICARE is a registered trademark of the TRICARE Management Activity. All rights reserved. 1 This document contains commercial information of UnitedHealth Military & Veterans Services, LLC, is protected under 5 U.S.C. 552(b)(4), and, as such, may not be used, disclosed or reproduced, in whole or in part, outside the Government, without the express written permission of UnitedHealth Military & Veterans Services, LLC.
2 Family Member Access User Guide This document will show you how to: Grant and remove family members access to your uhcmilitarywest.com account. Grant family members access to another family members uhcmilitarywest.com account (only available to sponsors). Hide and unhide family members names from your view on your uhcmilitarywest.com account. Standard access will be: All sponsors* and beneficiaries* may view their own account on uhcmilitarywest.com. An adult beneficiary can provide another adult beneficiary* in his or her family, access to his or her own account. A sponsor can provide an adult beneficiary access to view the accounts of beneficiaries age 0 to 12. All sponsors have access to the accounts of beneficiaries age 0 to 17 in his or her family, unless that beneficiary is a Spouse. Any beneficiary age 13 or older who does not wish the sponsor or other adult beneficiary (age 18 or older) to have access to his or her information may create a portal account and remove the sponsor or other adult beneficiary s access to their information. Or they may complete a Restriction Request form. The form is located under Beneficiaries > Find a Form > Privacy Release Form. *Terms Defined: Sponsor is defined as the holder of the TRICARE plan. Beneficiary is defined as the dependent of the sponsor on the TRICARE plan. Adult Beneficiary is defined as a beneficiary age 18 or older or a Spouse of the sponsor on the TRICARE plan. Note: A "family member" is anyone that is under the Sponsor s health plan and eligible in the Defense Enrollment Eligibility Reporting System (DEERS). This can include ex-spouses and stepchildren if the Sponsor still covers them for health insurance. The current DEERS information will display on the website. Note: Information related to sensitive Protected Health Information (PHI) is not available online. Sensitive PHI is protected health information related to the identity, diagnosis, prognosis, or treatment of any beneficiary in connection with reproductive health, substance abuse, HIV, rape, sexually transmitted diseases, mental health, and abuse (such as sexual assault and domestic violence). 2
3 Grant or Remove Family Member Access 1. Register or logon to your account. The family member you want to grant access to view your information must also have their own active uhcmilitarywest.com account, have an active TRICARE West Region plan and be age 18 or older. Notes: When registering as a Sponsor, you will have access to the accounts of beneficiaries age 0 to 17 in your family. When registering as an adult beneficiary (age 18 or older), you will only be able to view your own information until the Sponsor or another family member grants you access to view their information. When registering as a beneficiary (age 0 to 17), you will only be able to view your own information and will not have access to view other family members. 3
4 Grant or Remove Family Member Access 2. Navigate to the My Profile page. 3. Click the Manage List link under Privacy Settings. Note: In order to grant family members access to view your information, they must have their own uhcmilitarywest.com account, an active TRICARE West Region plan and be age 18 or older to be able to view your information. 4
5 Grant or Remove Family Member Access You will see a list of all family members who are: Eligible and covered by the Sponsor's health plan In the TRICARE West Region (based on ZIP Code in DEERS) The grayed out names are those you cannot grant or remove access. The reason is displayed to the right of their name. 4. Click the box next to the family member who should have access to your account. 5. Click the Save button. Note: In order to grant family members access to view your information, they must have their own uhcmilitarywest.com account, an active TRICARE West Region plan and be age 18 or older to be able to view your information. 5
6 Grant or Remove Family Member Access Confirmation of the change will appear. To remove a family member s access, repeat steps 1 5. This time un-check the person who should no longer have access to your account. 6
7 Grant Access to View Under 13 Family Members The sponsor can grant viewing access of the account of any minor beneficiary (under 13) to any adult beneficiary (age 18 or older) in his or her family. 1. Register or logon to your account. 2. Navigate to the My Profile page. 3. Click the Specify Access link under Privacy Settings. Note: The family member you wish to grant access to view an under age 13 beneficiary s information must have their own uhcmilitarywest.com account, an active TRICARE West Region plan and be age 18 or older. 7
8 Grant Access to View Under 13 Family Members You will see a list of all family members who are: Eligible and covered by the Sponsor's health plan In the TRICARE West Region (based on ZIP Code in DEERS) 4. Select the adult family member to be granted viewing access to an under age 13 beneficiary s information from the dropdown list. (See note below). Note: The family member you wish to grant access to view an under age 13 beneficiary s information must have their own uhcmilitarywest.com account, an active TRICARE West Region plan and be age 18 or older. 8
9 Grant Access to View Under 13 Family Members 5. Click the box next to the under age 13 beneficiary whose information the selected adult may view. 6. Click the Save button. Confirmation of the change will appear. To remove a family member s access, repeat steps 1 5. This time un-check the person who should no longer have access to the under age 13 beneficiary account. 9
10 Hide and Unhide Family Members 1. Register or logon to your account. 2. Navigate to the My Profile page. 3. Select the Hide Member link under Privacy Settings. Note: Only beneficiaries age 13 or older may hide a family member from their view on uhcmilitarywest.com. 10
11 Hide and Unhide Family Members 4. Click the box next to the family member(s) that you wish to no longer be visible to you on uhcmilitarywest.com and click Save. Confirmation of the change will appear. To unhide a family member and make them visible to you, repeat steps 1-4. This time un-check the family member you no longer wish to hide. 11
HOW TO USE THE RESOURCE LOCATOR
HOW TO USE THE RESOURCE LOCATOR The Resource Locator is an online searchable directory of resources in the Washington, DC metropolitan area. It is searchable by category of service or by location, and
The HIPAA Privacy Rule: Overview and Impact
The HIPAA Privacy Rule: Overview and Impact DISCLAIMER: This information is provided as is without any express or implied warranty. It is provided for educational purposes only and does not constitute
Address Update Web Application. User Manual. Defense Manpower Data Center Department of Defense
Defense Manpower Data Center Department of Defense Address Update Web Application User Manual Abstract This guide describes how to use Address Update Web Application to update contact information stored
Application for Residential Treatment Center Placement (Must be completed by family)
Application for Residential Treatment Center Placement (Must be completed by family) This statement serves to inform you of the purpose for collecting personal information required by TRICARE Health Net
How To Complete The Kcdcoastal Health Cooperative'S Authorization To Disclose Protected Health Information Form
Authorization to Use and Disclose Protected Health Information Form Under the HIPAA Privacy Rule, an individual may authorize the release of his or her protected health information (PHI) to a specific
HIPAA Policy Use and Disclosure of Protected Health Information November 3, 2015
HIPAA Policy Use and Disclosure of Protected Health Information November 3, 2015 SCOPE This policy applies to Florida Atlantic University s Covered Components and those working on behalf of the Covered
A Quick Summary for Domestic Violence Advocates
A Quick Summary for Domestic Violence Advocates of the March 2010 HMIS Final Regulations The final regulations for HMIS were released in March 2010 and these regulations are generally a positive step in
Department of Veterans Affairs Post-9/11 GI Bill Title 38 U.S.C. Chapter 33. Presented By Norman Chichester & Mary Boone PHS VA Coordinator
Department of Veterans Affairs Post-9/11 GI Bill Title 38 U.S.C. Chapter 33 Presented By Norman Chichester & Mary Boone PHS VA Coordinator 1 Post-9/11 GI Bill Eligibility You are eligible for benefits
TRICARE SENIOR PRIME ENROLLMENT APPLICATION
TRICARE SENIOR PRIME ENROLLMENT APPLICATION Form Approved OMB No. 0720-0018 Expires Aug 31, 2002 FOR OFFICIAL USE ONLY: PROPOSED EFFECTIVE DATE OF COVERAGE The public reporting burden for this collection
OFFICE OF THE ASSISTANT SECRETARY OF DEFENSE
OFFICE OF THE ASSISTANT SECRETARY OF DEFENSE HEALTH AFFAIRS 7700 ARlIngTOn BOUlEVARD, SUITE 5101 FAllS CHURCH, VA 22042-5101 TRICARE MANAGEMENT ACTIVITY February 15, 2013 Dear TRICARE Beneficiary: The
Sarasota Personal Medicine 1250 S. Tamiami Trail, Suite 202 Sarasota, FL 34239 Phone 941.954.9990 Fax 941.954.9995
Sarasota Personal Medicine 1250 S. Tamiami Trail, Suite 202 Sarasota, FL 34239 Phone 941.954.9990 Fax 941.954.9995 NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY
NOTICE OF PRIVACY PRACTICES OF THE GROUP HEALTH PLANS SPONSORED BY ACT, INC.
NOTICE OF PRIVACY PRACTICES OF THE GROUP HEALTH PLANS SPONSORED BY ACT, INC. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
UNIVERSITY OF SOUTHERN CALIFORNIA USC NETWORK MEDICAL PLAN, DELTA DENTAL PLAN, USC SENIOR CARE PLAN AND HEALTHCARE FLEXIBLE SPENDING ACCOUNT PLAN NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW HEALTH
DESCRIPTION OF H.R. 5458, THE VETERANS TRICARE CHOICE ACT
DESCRIPTION OF H.R. 5458, THE VETERANS TRICARE CHOICE ACT Scheduled for Markup by the HOUSE COMMITTEE ON WAYS AND MEANS on June 15, 2016 Prepared by the Staff of the JOINT COMMITTEE ON TAXATION June 14,
Northern Illinois Health Insurance Program HIPAA NOTICE OF PRIVACY PRACTICES PLEASE READ CAREFULLY
Northern Illinois Health Insurance Program HIPAA NOTICE OF PRIVACY PRACTICES PLEASE READ CAREFULLY This notice describes how medical information about you may be used and disclosed and how you can get
SUMMARY: The Defense Health Agency proposes to alter an. existing system of records, EDTMA 02, entitled "Medical/Dental
This document is scheduled to be published in the Federal Register on 10/27/2015 and available online at http://federalregister.gov/a/2015-27229, and on FDsys.gov Billing Code: 5001-06 DEPARTMENT OF DEFENSE
MEDICAL BENEFITS CLASS ACTION SETTLEMENT NOTICE OF INTENT TO SUE
MEDICAL BENEFITS CLASS ACTION SETTLEMENT NOTICE OF INTENT TO SUE Complete this form if you are a MEDICAL BENEFITS SETTLEMENT CLASS MEMBER seeking to exercise a BACK END LITIGATION OPTION. In addition to
https://www.ebenefits.va.gov
https://www.ebenefits.va.gov ebenefits is a portal; a central location for Wounded Warriors, Veterans, Service Members, their Families, and those who care for them to research, find, access, and manage
ROWAN UNIVERSITY POLICY
ROWAN UNIVERSITY POLICY Title: Authorization for Release of Information and Providing Patients with Copy of Medical Records Subject: IRT Clinical Systems Policy No: Applies: School of Osteopathic Medicine
Graphic Communications National Health and Welfare Fund. Notice of Privacy Practices
Notice of Privacy Practices Section 1: Purpose of This Notice and Effective Date THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
VALPARAISO UNIVERSITY NOTICE OF PRIVACY PRACTICES. Health, Dental and Vision Benefits Health Care Reimbursement Account
VALPARAISO UNIVERSITY NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Pastors and Domestic and Sexual Violence Survey of 1,000 Protestant Pastors
Pastors and Domestic and Sexual Violence Survey of 1,000 Protestant Pastors Sponsored by: Sojourners and IMA World Health 2 Methodology The telephone survey of Protestant pastors was conducted May 7-31,
Daughters of Charity Health System Employee Health Insurance Notice of Privacy Practices
Daughters of Charity Health System Employee Health Insurance Notice of Privacy Practices THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
Grand Rapids Medical Education Partners Mercy Health Saint Mary s Spectrum Health. Pam Jager, GRMEP Director of Education & Development
Grand Rapids Medical Education Partners Mercy Health Saint Mary s Spectrum Health Pam Jager, GRMEP Director of Education & Development To understand the requirements of the federal Health Information Portability
JEWISH FAMILY SERVICE NOTICE OF PRIVACY PRACTICES
Jewish Family Service takes pride in treating our clients and each other with respect and dignity. Protecting your health information is very important to us. We want you to have a clear understanding
We are required to provide this Notice to you by the Health Insurance Portability and Accountability Act ("HIPAA")
PRIVACY NOTICE We are required to provide this Notice to you by the Health Insurance Portability and Accountability Act ("HIPAA") THIS NOTICE DESCRIBES HOW PERSONAL AND MEDICAL INFORMATION ABOUT YOU MAY
E-QIP/CLICK TO SIGN!!
E-QIP/CLICK TO SIGN!! INSTRUCTIONS FOR THE SUBJECTS/APPLICANTS Click-to-Sign (CTS) instructions for the Certification (CER), Fair Credit Release (FCR), General Release (REL), and Medical Release (MEL)
DETAILED NOTICE OF PRIVACY AND SECURITY PRACTICES OF THE Trustees of the Stevens Institute of Technology Health & Welfare Plan
DETAILED NOTICE OF PRIVACY AND SECURITY PRACTICES OF THE Trustees of the Stevens Institute of Technology Health & Welfare Plan THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
Privacy Issues and the Children s s Hospital EMR
Privacy Issues and the Children s s Hospital EMR This roundtable discussion is brought to you by the Children s s Hospital Affinity Group of the In-House Counsel (In- House) and Teaching Hospitals and
New York Enrolling a New Small Group (1-50) in IDEA
New York Enrolling a New Small Group (1-50) in IDEA We listened to what you had to say and now it s easier than ever to enroll new small groups (1-50) with our online enrollment tool, Idea Management System
Victim Information. Other Information. How did you find out about the CVCP? Check the box that applies: Police/Law Enforcement
Department of Labor and Industries Crime Victims Compensation Program PO Box 44520 Olympia WA 98504-4520 Email: CrimeVictimsProgramM@LNI.WA.GOV Fax: (360) 902-5333 Crime Victim s Application for Benefits
HIPAA Compliance and HIE
HIPAA Compliance and HIE Andrew Lombardo, Director Rio Grande Valley HIE 1413 Stuart Place Ste. B Harlingen, Texas Email: Andrew@rgvhie.org Phone: 956.622.5801 Fax: 866-650-8035 Agenda Insert diagram to
How To: Change Supplemental Life, AD/D, and Disability Coverage
1. Log onto www.mykmxhr.com through the CarMax World or from your home computer. On the home page, click [My Benefits]. A new window will appeal for you to make your Benefit elections 2. Click the [Declare
GONZABA MEDICAL GROUP PATIENT REGISTRATION FORM
GONZABA MEDICAL GROUP PATIENT REGISTRATION FORM DATE: CHART#: GUARANTOR INFORMATION LAST NAME: FIRST NAME: MI: ADDRESS: HOME PHONE: ADDRESS: CITY/STATE: ZIP CODE: **************************************************************************************
HIPAA Privacy Policies
HIPAA Privacy Policies Healthcare Insurance Portability and Accountability Act of 1996 (HIPAA) The HIPAA Privacy Rule created a national standard to protect patient s medical records and other personal
Chicago Homeless Management Information System (HMIS) Privacy Packet
Chicago Homeless Management Information System (HMIS) Privacy Packet Table of Contents Standard Agency Privacy Practices Notice... 3 Chicago Standard HMIS Privacy Posting... 6 Client Consent Form for Data
Strategies for Electronic Exchange of Substance Abuse Treatment Records
Strategies for Electronic Exchange of Substance Abuse Treatment Records Patricia Gray, J. D., LL. M. Prepared for the Texas Health and Human Services Commission and the Texas Health Services Authority
Harris County - Texas HIPAA Notice of Privacy Practices
Harris County - Texas HIPAA Notice of Privacy Practices Effective Date: September 23, 2013. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
Life Insurance Policy Information. Policyowner(s) (please print clearly) insurance company policy number issue date (00/00/0000)
L I F E S E T T L E M E N T Q U E S T I O N N A I R E (please print clearly) Life Insurance Policy Information insurance company policy number issue date (00/00/0000) face amount total policy loan cash
Life Insurance Policy Information. Policyowner(s)
L I F E S E T T L E M E N T A P P L I C A T I O N Life Insurance Policy Information insurance policy number issue face amount total policy loan cash surrender value annual premium payment next premium
Purposes for Which the Plan May Use or Disclose PHI Without Your Authorization
BOWDOIN COLLEGE HEALTH PLAN BOWDOIN COLLEGE DENTAL PLAN BOWDOIN COLLEGE VISION PLAN BOWDOIN COLLEGE HEALTH CARE REIMBURSEMENT PLAN NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION
First Name MI Last. Street Address (P.O. Boxes cannot be accepted) City State Zip. First Name MI Last
Accident Claim Form Instructions for Filing a Claim LIFESECURE INSURANCE COMPANY ADMINISTRATIVE OFFICE ATTN: Claims Department PO Box 13490, Pensacola, FL 32591-3490 1-888-575-8246 Please have all sections
IDAHO STATE UNIVERSITY POLICIES AND PROCEDURES (ISUPP) HIPAA Privacy Use and Disclosure of Psychotherapy Notes 10130
IDAHO STATE UNIVERSITY POLICIES AND PROCEDURES (ISUPP) HIPAA Privacy Use and Disclosure of Psychotherapy Notes 10130 POLICY INFORMATION Major Functional Area (MFA): MFA X - Office of General Counsel &
insurance company policy number issue date (00/00/0000) face amount total policy loan cash surrender value amount paid
LIFE SETTLEMENT QUESTIONNAIRE (please print clearly) Life Insurance Policy Information policy number issue date (00/00/0000) face amount total policy loan cash surrender value annual premium payment next
Perform this procedure when you need to add a recurring payment option, or when you need to change or withdraw it.
Purpose Use this procedure to add, change, or remove recurring payments. Trigger Perform this procedure when you need to add a recurring payment option, or when you need to change or withdraw it. Prerequisites
MERCY HEALTH MEDICAL TRANSPORTATION SERVICES PRIVACY NOTICE Revised Notice Effective Date: September 23, 2013
MERCY HEALTH MEDICAL TRANSPORTATION SERVICES PRIVACY NOTICE Revised Notice Effective Date: September 23, 2013 THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU
Pacific Medical Centers HIPAA Training for Residents, Fellows and Others
Pacific Medical Centers HIPAA Training for Residents, Fellows and Others Summary of Critical Pacific Medical Centers (PMC) HIPAA Policies and Procedures For additional information or questions, please
NORTHERN NEW ENGLAND BENEFIT TRUST LIFE INSURANCE ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE
NORTHERN NEW ENGLAND BENEFIT TRUST LIFE INSURANCE ACCIDENTAL DEATH & DISMEMBERMENT INSURANCE LIFE INSURANCE ACCIDENTAL DEATH AND DISMEMBERMENT INTRODUCTION Life Insurance and Accidental Death & Dismemberment
DMDC Reserve Component Purchased TRICARE Application (RCPTA) User Manual
Defense Manpower Data Center Department of Defense DMDC Reserve Component Purchased TRICARE Application (RCPTA) User Manual Abstract This guide describes how to use the RCPTA, which allows Selected Reserve
NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES (HIPAA)
NOTICE OF HEALTH INFORMATION PRIVACY PRACTICES (HIPAA) THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Create a Room Block in the Hotel Center?
Create a Room Block in the Hotel Center? To create a room block for an event in the Hotel Center, click on the Room Blocks tab Click on the button to get to the add room block page Revised 6/1/10 by SignUp4
ILLUSTRATED INSTRUCTIONS BEGIN ON THE NEXT PAGE
Add or Change Life Insurance Beneficiaries Please visit the Benefits web site for comprehensive information about Basic life insurance and Supplemental life insurance. Click on a staff category from the
U.S. Department of Veterans Affairs / Department of Defense
Website Overview : ebenefits Users Veterans Service members Family members eligible for benefits (legal dependents over age 18) 9 Website Overview : Website Navigation Overview To Register click here Claims
Rehabilitation, Sports & Spine Center, P.S. Notice of Privacy Practices. l. Use and Disclosures of Protected Health Information
Rehabilitation, Sports & Spine Center, P.S. Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Metropolitan Living, LLC 151 W. Burnsville Parkway, Suite 101 Burnsville, MN 55337 Ph: (952) 564-3030 Fax: (651) 925-0031
The Health Insurance Portability and Accountability Act (HIPAA) and Client Privacy Statement This notice describes how your medical information may be used and disclosed and how you can get access to this
NOTICE OF HEALTH INFORMATION PRACTICES
NOTICE OF HEALTH INFORMATION PRACTICES Effective Date: April 14, 2003 Date Amended: 9/5/13 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
CBIA Service Corporation Privacy and Security Notice
July 1, 2012 CBIA Service Corporation Privacy and Security Notice THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
Notice of Privacy Practices
LiveWell Group 7781 Cooper Road 2 nd floor Suite 5 Cincinnati OH, 45242 Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET
Updated Small Business Marketplace Portal Functionality. Employment Classes & New Hire Waiting Period criteria
Health Option Riders Updated Small Business Marketplace Portal Functionality The Religious Exemption health option rider and Domestic Partner health option rider have been moved to the employer group level,
Process Document Student Self-Service: Making Credit Card Payments. Making Credit Card Payments. Concept
Making Credit Card Payments Concept The Campus Finance component of Student Self-Service enables students to access their student bill information and manage their charges and payments. This topic covers
I. Individual (Name and information of person whose protected health information is being disclosed): Jane Doe 05-10-1962
Instructions for Completing Standard Authorization Form To Complete Form go to Page 4 of 5 Use this form to authorize Blue Cross Blue Shield of Texas to disclose your protected health information (PHI)
MILITARY HEALTH SYSTEM NOTICE OF PRIVACY PRACTICES. Effective April 14, 2003
HEALTH AFFAIRS MILITARY HEALTH SYSTEM NOTICE OF PRIVACY PRACTICES Effective April 14, 2003 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
Dear New Lilly Associate and Spouse or Domestic Partner:
Eli Lilly and Company Lilly Corporate Center Indianapolis, Indiana 46285 U.S.A. +1.317.276.2000 www.lilly.com Dear New Lilly Associate and Spouse or Domestic Partner: Eli Lilly and Company is required
Dr. Adam Apfelblat 5140 Highland Road Waterford 48327 Phone: (248)618-3467 Fax: (248)618-3515
Dr. Adam Apfelblat 5140 Highland Road Waterford 48327 HIPAA NOTICE OF PRIVACY PRACTICES PLEASE REVIEW THIS NOTICE CAREFULLY. IT DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW
Attachment B HIPAA-P03 Instructions for Completing IU s Authorization for Research Purposes
Attachment B HIPAA-P03 Instructions for Completing IU s Authorization for Research Purposes The HIPAA Privacy Rule generally prohibits health care providers from using or releasing protected health information
Section A Victim/Applicant Information (A separate application must be completed for each victim.)
Application For Crime Victim Compensation Claim No. Arkansas Crime Victims Reparations Board 323 Center Street, Suite 200 Little Rock, Arkansas 72201 Office of the (501) 682-1020 or 1-800-448-3014 This
Nurses Provide Assistance by Telephone
Nurses Provide Assistance by Telephone Nurse Advice Line provides TRICARE beneficiaries with health care advice or same-day appointments for urgent health problems The Nurse Advice Line supports nearly
Notice of Privacy Practices
Notice of Privacy Practices This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully. This Notice of
HIPAA Templates. Health Plan Privacy Edition Version 2.4. Policy and Procedure Templates
SAMPLE CLAYTON - MACBAIN HIPAA Templates Health Plan Privacy Edition Version 2.4 Policy and Procedure Templates Reflects modifications published in the August 14, 2002, Federal Register William A. MacBain,
The Health and Benefit Trust Fund of the International Union of Operating Engineers Local Union No. 94-94A-94B, AFL-CIO. Notice of Privacy Practices
The Health and Benefit Trust Fund of the International Union of Operating Section 1: Purpose of This Notice Notice of Privacy Practices Effective as of September 23, 2013 THIS NOTICE DESCRIBES HOW MEDICAL
MILWAUKEE ROOFERS HEALTH FUND
MILWAUKEE ROOFERS HEALTH FUND PRIVACY PRACTICES NOTICE October 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE
Illinois Standard Health Employee Application for Small Employers
Illinois Standard Health Employee Application for Small Employers INSURER USE ONLY Policy/Group No. Section No. Effective Date New Hire Waiting Period For assistance in completing this application, please
OrthoSynetics, Inc. 2016 Medical, Dental, and Vision On-line Open Enrollment Instructions
OrthoSynetics, Inc. 2016 Medical, Dental, and Vision On-line Open Enrollment Instructions 1. Log onto My Payroll Page (https://oca.ultipro.com). Please disable any pop-up blockers you may have installed
Protected Health Information
Protected Health Information What Is Covered? Protected health information (PHI) Individually identifiable health information Transmitted or maintained in any form or medium by a Covered Entity or its
Patti Levin, LICSW, Psy.D. Clinical Psychologist
Patti Levin, LICSW, Psy.D. Clinical Psychologist 673 Boylston St. #4. 617.227.2008 Boston, MA02116 fax: 617.247.7523 www.drpattilevin.com email:patti@drpattilevin.com Notice of Privacy Practices (HIPAA)
Chief Privacy Officer Christian Brothers Services 1205 Windham Parkway Romeoville, IL 60446-1679 cpo@cbservices.org 800-807-0100
Summary of Notice of Privacy Practices for Christian Brothers Prescription Drug Program Christian Brothers Services is the program sponsor of the Christian Brothers Prescription Drug Program (the Program
PRIVACY PRACTICES OUR PRIVACY OBLIGATIONS
PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. General Information To comply
DIRECT MESSAGING END USER GUIDE ALABAMA ONE HEALTH RECORD. Unify Data Management Platform 2012/2013 Software Build 5.15
DIRECT MESSAGING END USER GUIDE ALABAMA ONE HEALTH RECORD Unify Data Management Platform 2012/2013 Software Build 5.15 April 2015 Proprietary and Confidential Property of Truven Health Analytics Inc.
Customer to Partner Relationship
Customer to Partner Relationship Contents Introduction... 2 Creating a new Partner relationship... 2 Updating or activating an existing relationship... 3 Field descriptions... 3 Logging a ticket on behalf
HIPAA Privacy Rule CLIN-203: Special Privacy Considerations
POLICY HIPAA Privacy Rule CLIN-203: Special Privacy Considerations I. Policy A. Additional Privacy Protection for Particularly Sensitive Health Information USC 1 recognizes that federal and California
NOTICE OF PRIVACY PRACTICES effective April 14, 2003
NOTICE OF PRIVACY PRACTICES effective April 14, 2003 This document outlines the privacy practices of Dental Clinic of Marshfield S.C. and Dental Com Insurance Plan, Inc. All references to Dental Clinic
Notice of Privacy Practices
Notice of Privacy Practices THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
CALIFORNIA Small Business Employee Enrollment Form
CALIFORNIA Small Business Employee Enrollment Form To speed the enrollment process, please be thorough and fill out all sections that apply. To Be Completed by Employer Requested Effective Date of Insurance
Enrollment 4. Client Profile 10. Household 12. Program Intake 13. Anonymous Hotline Calls 18. Client Profile Tier 2 Forms 19.
User Manual Contents Enrollment 4 Creating an Enrollment record... 6 Creating/Selecting Records for an Enrollment... 7 Existing Profile Record... 7 New Client (No Profile Record)... 8 Completing the Enrollment...
Notice of Privacy Practices
Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Privacy is a very
NOTICE OF PRIVACY PRACTICES
GLOUCESTER COUNTY PUBLIC SCHOOLS EMPLOYEE HEALTH CARE PLAN, GLOUCESTER COUNTY PUBLIC SCHOOLS EMPLOYEE DENTAL CARE PLAN, GLOUCESTER COUNTY PUBLIC SCHOOLS EMPLOYEE FLEXIBLE BENEFITS PLAN 1 NOTICE OF PRIVACY
IBM MobileFirst Protect (MaaS360) Mobile Enterprise Gateway Migration Guide
IBM MobileFirst Protect (MaaS360) Mobile Enterprise Gateway Migration Guide Version 2.3.0 Copyright 2015 Fiberlink, an IBM Company. All rights reserved. Information in this document is subject to change
MathXL Getting Started Guide for Instructors
MathXL Getting Started Guide for Instructors Copyright Notice Copyright 2013 by Pearson Education. All rights reserved. No part of the contents of this book may be reproduced or transmitted in any form
TABLE OF CONTENTS. SECTION 1: How to Access Employee Self Service 2. SECTION 2: Enrolling in Benefits Plans 3 29
Guide to Enrolling for Benefits with Employee Self Service Step by Step Instructions TABLE OF CONTENTS PAGES SECTION 1: How to Access Employee Self Service 2 SECTION 2: Enrolling in Benefits Plans 3 29
VA BENEFITS FOR SERVICEMEMBERS, VETERANS, AND FAMILIES. Veterans and the Fully Developed Claims (FDC) Program VETERANS BENEFITS ADMINISTRATION
VA BENEFITS FOR SERVICEMEMBERS, VETERANS, AND FAMILIES Veterans and the Fully Developed Claims (FDC) Program SUMMER 2013 Asking Questions Audience polls, questions and answers, and chat broadcasts will
Arizona Life Settlement Qualification Form
PERSONAL INFORMATION Arizona Life Settlement Qualification Form First Insured Name: SS # Current Address: City: State: Zip: Date of Birth: Driver s License Number: State: Expiration: Second Insured Name:
Department of Health and Human Services Policy ADMN 004, Attachment A
WASHINGTON COUNTY Department of Health and Human Services Policy ADMN 004, Attachment A HHS Confidentiality Agreement Including HIPAA (Health Information Portability and Accessibility Act of 1996) OREGON
For the purposes of this Policy and Procedure, the following definitions apply:
Policies and Procedures TOPIC: Patient Opt-Out Choice and Meaningful Disclosure Policy #: TBD Effective Date: TBD I. BACKGROUND AND PURPOSE The purpose of this policy is to describe how the participation
REGISTRATION FEE REIMBURSEMENT PLAN
REGISTRATION FEE REIMBURSEMENT PLAN The terms and conditions of the Registration Fee Reimbursement Plan (herein called the Plan ) described below apply to the event for which you have registered and that
What is Covered under the Privacy Rule? Protected Health Information (PHI)
HIPAA & RESEARCH What is Covered under the Privacy Rule? Protected Health Information (PHI) Health information + Identifier = PHI Transmitted or maintained in any form (paper, electronic, forms, web-based,
Enrollment Form for Assurant Cancer and Heart/Stroke Fixed Indemnity Insurance
Enrollment Form for Assurant Cancer and Heart/Stroke Fixed Indemnity Insurance PLEASE PRINT IN BLACK INK PERSONS TO BE INSURED Attach a separate sheet, signed and dated, if additional space is needed.
Notice of Privacy Practices
SHANNON LERACH, Ph.D. Licensed Clinical Psychologist PSY23705 243 N. Highway 101, Suite 16, Solana Beach, CA 92075 Telephone: (619) 817.5320 Fax: (858) 481.1674 Notice of Privacy Practices This Notice
Polk Medical Center Notice of Privacy Practices
Polk Medical Center Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
An Employer s Introduction to HIPAA Prepared by Ballard, Rosenberg Golper & Savitt, LLP
An Employer s Introduction to HIPAA Prepared by Ballard, Rosenberg Golper & Savitt, LLP Important Disclaimer: Practice limited to labor and employment law on behalf of management and related litigation.
650 Clark Way Palo Alto, CA 94304 650.326.5530
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. (Adopted 4-14-03; revised December 2006) If