How can I tell the Department to share my protected health information with a family member, friend, or other third party?

You may want us to speak with or share your health information with someone you choose to assist you with your Medical Assistance Program benefits.

• • If you want to authorize the Department to share with your family member or close friend, use our Personal Representative Form. This authorization does not expire unless you choose an expiration date.  You will need to sign the form, have your Personal Representative sign the form and return it together with copies of your identification.

• If you want to authorize the Department to share your health information with an attorney, insurance company, advocate or assistant for a specific purpose, please use our Third-Party Authorization Form. This authorization expires in 1 year, unless you choose an expiration date. You will need to sign the form and return it together with copies of your identification.