Privacy forms

Use these forms to set the access to your health plan records and to request confidential communications. You may be able to fill out some of these forms on your computer, then print, sign (if necessary) and send them using the instructions on the form.

If you need help, contact Providence Health Assurance Customer Service: 503-574-8200 or 1-800-898-8174 (TTY: 711), Monday through Friday, 8 a.m. to 5 p.m.