Individual Forms


	HIPAA Forms


	Download Instructions:

	Adobe Acrobat Reader software is required to view, print and search these PDF documents. Please download this free software on the Adobe Acrobat Web site. Please note that Blue Cross of California does not provide Technical Support for Acrobat Reader Software. For technical support, please contact Adobe.



	To use these forms:

		1. Download and install Acrobat Reader. 2. Select the form you would like to complete. 3. Use Acrobat Reader and your printer to print the form. 4. Fill out the printed form. 5. See the form for specific mailing information.



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		Access to Records Form Authorization Form Authorization Revocation Form Complaint Form - BC Life & Health Complaint Form - BCC Confidential Communcation Request Request for Accounting of Disclosures Request for Amendment Request for Restrictions Form