Driscoll Health Plan (DHP) complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, disability, age, or sex.
We are required to provide this notice of our legal duties and privacy practices regarding uses and disclosures of PHI as well as inform you regarding your individual rights.
Use of the Service is governed by the terms and conditions of this Agreement. Please read this Agreement carefully before accessing or using the Service.
Authorization for Release of Protected Health Information (PHI)
This is a Protected Health Information (PHI) form. By completing this authorization form, you agree to allow Driscoll Health Plan (DHP) to share your PHI with the people listed on the form. The form must be completely filled out and signed by the person who applied for Medicaid benefits. If you have questions or need help filling out the form, please call 1-877-324-7543 and ask to speak to a Member Advocate.
