Use the ADHI form to grant Highmark and its subsidiaries and affiliates permission to share your information with trusted individual(s) that you choose.
You may request that we terminate previously granted permission for Highmark to release or disclose a member’s protected health information to other individuals.
If you would like to view or receive a copy of your Highmark maintained protected health information, please submit a request for access.
You may request a list of disclosures Highmark made of a member’s protected health information. Disclosures made for payment and health plan operations are excluded from this process.
Use this form to request limits or restrictions on disclosures of protected health information to others such as a family member, friend, spouse, doctor, or any other party.
You may use this form to request a correction to Highmark created protected health information that you believe is inaccurate or incomplete.
Use this form to request that Highmark communicate protected health information in a different way during life-threatening situations. Examples of alternate communications could include telephone, mail, e-mail, or a different address.
