These forms allow you to exercise your privacy rights by printing, completing, and mailing these forms to USAble Life, Privacy Office, P.O. Box 1650, Little Rock, AR 72203-1650.
Authorization - Appointment of Authorized Representative
Authorization - Release of Medical Records
Authorization - Request for Confidential Communication of PHI
Authorization - Request to Correct or Amend Maintained Records
Authorization - Request to Inspect Health Information
Authorization - Request to Restrict Use and Disclosure Health Information
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