Authorization to Use or Disclose Protected Health Information
Providers and community partners can use this form to request that the Alliance release information related to an Alliance member that is considered to be protected health information (PHI). The form is available in English, Spanish and Hmong.
Contact Member Services
- Monday through Friday, from 8 a.m. to 5:30 p.m.
- Phone: 800-700-3874
- Deaf and Hard of Hearing Assistance
Alliance TTY Line: 877-548-0857
- Nurse Advice Line
Accessing Alliance Services
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