Patient forms and information (4)
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PHI Access Request – Infusion
Complete and return this form if you would like to access and inspect the information Optum Infusion Pharmacy maintains and uses to make decisions about the services we provide you.
PHI Amendment – Infusion
Complete and return this form if you would like to amend the records Optum Infusion Pharmacy maintains about you if they are inaccurate or incomplete.
PHI Non-Routine Disclosure – Infusion
Complete and return this form if you would like to receive an accounting of certain disclosures of PHI made by Optum Infusion Pharmacy.
PHI Restriction – Infusion
Complete and return this form if you would like to request restrictions on certain uses and disclosures of your PHI from Optum Infusion Pharmacy.