Federal Employee Program Forms - Member Services - CareFirst BlueCross BlueShield

Forms

Federal Employee Program (FEP)

These forms deal with your protected health information (PHI). For questions concerning your membership and benefits, or to obtain other FEP forms, contact Member Services at the telephone number on your ID card or visit www.fepblue.org.

Form

Form Number

Access to PHI Form

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Accounting of Disclosure Form

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Amendment to PHI Form

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Personal Representative Form

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Authorization Form for Information Release

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Revocation Form for Information Release or Personal Representative

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Restrict PHI Access Form

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Terminate Restriction to PHI Form

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Advance Directives

Form Number

As a convenience for members, we are providing links to the Maryland Attorney General's Web site to access information on Advance Directives and Living Wills.

Information Sheet

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Forms

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