If you would like us to discuss your information with someone other than yourself, please fill out the Authorization for Disclosure of Protected Health Information form, which is available at QuartzBenefits.com/phiform or in MyChart.
You can specify which information may be released to named people or entities. You may authorize anyone, including a friend, a family member, or an employer or potential employer.
Once completed, you can return it to Quartz, and an authorization will be entered to allow the release of the requested information.
When May Protected Health Information (PHI) Be Released Without a Member’s Authorization?
- To parents of a minor after verifying the parent’s identity and if permitted under the law.
- HIPAA enforcement purposes.
- For Quartz’s payment and health care operations purposes.
- When required by law (example: a court order requires it).
- Other uses/disclosures required or by law.
