HIPAA Privacy Forms

By law, the APWU Health Plan is required to protect the privacy of your personal health information. The APWU Health Plan is also required to give you this Notice to tell you how the APWU Health Plan may use and/or share your personal health information held by the APWU Health Plan. To learn more about our privacy practices click Notice of Privacy Practices.

Forms for members to download, fill out and return:

1. Explanation of HIPAA Forms
2. Authorization for Release of Protected Health Information
3. Personal Representative Authorization
4. Request for Access
5. Request for Accounting of Disclosures
6. Request for Amendment
7. Request for Confidential Communications
8. Request for Restriction

Certificate of Group Health Plan Coverage

In order to view the Notice of Privacy Practices and forms, you will need to have Adobe Acrobat Reader installed on your computer. To download this free program, click on the Get Acrobat Reader button.

The APWU Health Plan reserves the right to modify this legal disclaimer and privacy policy at any time. If you have questions about the privacy statement or the practices of this web site, you should contact information@apwuhp.com.