Member Rights Forms:

• Authorization to Release Protected Health Information* - pdf
• General Authorization to Release Protected Health Information to Member Designee
• Member Record Amendment/Correction* - pdf
• Request for Restriction on Use and Disclosure of Health Information and/or Confidential Communication * - pdf

All forms, except the Member Record Amendment/Correction form, must be notarized to be valid.

*These publications are available in PDF (portable document format). To view and print these publications, Adobe® Acrobat® Reader™ must be installed on the user's PC. Acrobat® Reader™ is available free of charge at www.adobe.com .

Discover more about HIPAA and the Privacy Rule.

• MCHCP's Privacy Practices
• What are your rights as a member with MCHCP?
• What is an MCHCPid?
• Why is MCHCP assigning ID numbers?
• How can you request Protected Health Information (PHI) from MCHCP?

If you have any questions or concerns, please contact MCHCP's Privacy Officer at 800.701.8881 or 573.751.8881.

Mail questions or concerns to:

MCHCP
Attention: Privacy Officer
832 Weathered Rock Court
P.O. Box 104355
Jefferson City, MO 65110

If you are aware of any fraud being perpetrated against MCHCP (i.e. covering ineligible dependents, filling prescriptions after termination of coverage, etc.), please notify MCHCP's Fraud Section at 800.701.8881. You can help reduce the costs of benefits for all covered members by saving MCHCP unnecessary expenses.