For Patients & Members

Protecting Your Privacy

Privacy of your medical information is protected by the Health Insurance Portability and Accountability Act of 1996. Generally referred to as “HIPAA,” this law limits how certain entities may use or share your health information. Midlands Choice considers its responsibilities under HIPAA to be of the utmost importance, not only because protecting your information is required by law, but also because it’s the right thing to do.

What is protected?

Individually identifiable health information, whether oral or recorded in any form or medium, that:

  1. Is created or received by a healthcare provider, health plan, public health authority, employer, life insurer, school or university, or healthcare clearinghouse; and
  2. Relates to the past, present, or future physical or mental health or condition of an individual; the provision of health care to an individual; or the past, present, or future payment for the provision of health care to an individual.

Healthcare providers, health insurance companies and employer group health plans may use your information:

  • For treatment and care coordination
  • For payment purposes to doctors and hospitals for your healthcare
  • For healthcare operations purposes
  • To make required reports to government authorities

Without your permission, health insurance companies and healthcare providers may not:

  • Give your information to your employer
  • Give your information to unauthorized family members (except parents regarding their minor children, under most circumstances)
  • Use or share your information for marketing or advertising purposes
  • Share private notes about your mental health counseling sessions

Print and complete this Authorization Form to permit disclosure of your personal health information to third parties, including family members.