Notice of Privacy Practices

The documents provided below describe how we can use and disclose health information we have about your American Specialty Health (ASH) members and how ASH members can access that information. Please refer to the Notice of Privacy Practices (NPP) for details about our current privacy practices. Your ASH members may contact our Member Services department at (800) 678-9133 for any questions. To view and/or print these PDF documents you will need Acrobat Reader installed.

If you are accessing these privacy forms on behalf of a member, please access the privacy forms via the appropriate Member portal.

Notice of Privacy Practices & Privacy Forms
Authorization for Release of Protected Health Information
Authorized Personal Representative Form
Confidential Communications Form
Notice of Privacy Practices (NPP)
Privacy Complaint
Request for Access to Protected Health Information
Request for Accounting of Disclosure of Protected Health Information
Request to Amend Protected Health Information
Request for Restriction of Use/Disclosure of Protected Health Information
National Association of Specialty Health Organizations

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