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Legal Notices and Forms

 

Legal Notices

  
  
HIPAA Privacy Notice.pdfHIPAA Privacy Notice
USERRA Notice on Health Insurance Rights.pdfUSERRA Notice on Health Insurance Rights
COBRA Notice.pdfCOBRA Notice
Children's Health Insurance Program.pdfChildren's Health Insurance Program
2017 Kentucky Marketplace Notice Part A Only.pdf2017 Kentucky Marketplace Notice Part A Only
2017 Kentucky Marketplace Notice Parts A and B.pdf2017 Kentucky Marketplace Notice Parts A and B
2017 Legal Notices.pdf2017 Legal Notices
2017 Terms and Conditions.pdf2017 Terms and Conditions
2017 Tobacco Use Declaration.pdf2017 Tobacco Use Declaration
2017 WHCRA Notice.pdf2017 WHCRA Notice
2017 Wellness Program Notice.pdf2017 Wellness Program Notice
2017 Medicare Prescription Drug Creditable Coverage Notice.pdf2017 Medicare Prescription Drug Creditable Coverage Notice

 

​Legal Forms

  
  
Authorization for Release of Information.pdfAuthorization for Release of Information
Request for Alternate Communications.pdfRequest for Alternate Communications
Request for Restrictions on Use or Disclosure of Protected Health Information.pdfRequest for Restrictions on Use or Disclosure of Protected Health Information
Request to Amend or Correct Protected Health Information.pdfRequest to Amend or Correct Protected Health Information
Request to Inspect or Copy Protected Health Information.pdfRequest to Inspect or Copy Protected Health Information
Request for Accounting of Disclosures of Protected Health Information.pdfRequest for Accounting of Disclosures of Protected Health Information

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