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Blue Cross and Blue Shield of New Mexico
HIPAA NOTICE OF PRIVACY PRACTICES

Privacy Forms

Standard Authorization Form Microsoft Word file

Standard Authorization Form Adobe Acrobat PDF

Instructions for Completing the Standard Authorization Form Microsoft Word file

Request to Access PHI Adobe Acrobat PDF

Request to Amend PHI Adobe Acrobat PDF

Request for Accounting of PHI Disclosures Adobe Acrobat PDF

Response to Denied Amendment Adobe Acrobat PDF

Confidential Communications Request Adobe Acrobat PDF

Restriction Request Adobe Acrobat PDF

HIPAA Complaint Adobe Acrobat PDF

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please note: This notice is intended for our fully insured/premium members. Those members of a self-funded plan should obtain a plan from your employer/group health plan.

Notice of Privacy Practices Adobe Acrobat PDF

Privacy - Contact Us

If you are concerned that your privacy rights have been violated, you may let us know by calling the number on the back of your member identification (ID) card. If you do not have an ID card and have a privacy concern you can reach us by calling 877-361-7594.

Written communications can be sent to:

Director, Privacy Office
P.O. Box 804836
Chicago, IL 60680-4110

 

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