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Manage Private Information (HIPAA)

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Request for Confidential Communications

Use this form to request communication of your private information by Braven Health and its business associates to be sent to an alternative location or as otherwise agreed.

ID: #40016 (0820)

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Request For Accounting Of Disclosures

This form must be completed when a member wants to request an accounting of disclosures of private information made by Braven Health. These will not include disclosures of private information made for purposes of treatment, payment or healthcare operations, disclosures to the member to whom the private information pertains, disclosures to a personal representative of the member, or as stipulated by federal or state privacy laws.