You can use this form to tell us how and where you want us to send confidential information about your protected health records.

What you’ll need:

  • Your enrollee ID card
  • A printer to print the form
  • An envelope and postage to mail the form, or a fax machine. Each form includes instructions, a mailing address and a fax number.

If you have any questions, please contact us.

Request for Confidential Communication (PDF)