Privacy Forms

Centennial Care members have rights related to their Protected Health Information (PHI). To exercise one of these rights, print out the form you want from the list below. Once you complete and sign the form, mail it to the address shown on that form. You can also contact Member Services at 1-866-689-1523 (TTY:711) and ask them to mail you a copy of the form you need.

1.0-2021