Privacy Practice Notice and Forms

This notice is for members of BCBSNM Group Plans, Individual and Family Plans, and Medicare Plans.

Medicaid plan members have their own Privacy Practices Notice. They get their notice from the state instead of from BCBSNM.

Use the forms below if you are covered by a BCBSNM health plan through your employer, or if you are covered by a BCBSNM Individual or Medicare health plan.

Use this form to ask BCBSNM to share your protected health information (PHI) with a certain person or entity. 

Use this form to ask BCBSNM for a copy of your PHI records.

Use this form to ask BCBSNM to update your PHI.

Use this form to get a record of how BCBSNM shared your PHI.

If you had a request to update your PHI denied by BCBSNM, use this form. You can ask that the original request and the denial be attached to future disclosures of your PHI.

Do you feel your life could be in danger if you get mail at your current address? Use this form to ask BCBSNM to restrict your PHI and communicate with you at an alternate location.

Use this form to ask BCBSNM to restrict your PHI from being used or shared with another person or non-covered entity under HIPAA.

Use this form to file a privacy or security complaint with BCBSNM.

Medicaid plan members have their own privacy forms. Go to: