Midwest Security HIPAA Forms

The following Midwest Security documents are provided for the use of our health plan members only. If you are a Midwest Security health plan member and have questions concerning the use of these forms, please contact your Midwest Security Customer Service Center.

• Guide for Completing HIPAA Authorization Form
• HIPAA Authorization Form
• HIPAA Request for Alternate Disclosure Form
• HIPAA Request to Access PHI Form
• HIPAA Request to Amend PHI Form

The above documents are available in Adobe Portable Document Format (PDF). If you don't already have a PDF viewer installed, a free version is available from Adobe Software. The free Adobe ® Acrobat ® Reader allows you to view, navigate, and print PDF files across all major computing platforms. To print a PDF document, click the printer icon button in the Adobe Acrobat menu bar, directly above the displayed document.