Skip to Main Content


The Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule gives you rights over your protected health information (PHI), including the right to get it, change it, share it, and monitor it.

The forms available at this site are for Optum interactions managed by us which are related to Behavioral (Mental) Health, an Optum Nurse, OptumRx Home Delivery Pharmacy, Chiropractic, and/or Physical/Occupational Therapy. Select “Forms” at the top of the page to submit a request related to this healthcare information.

For requests related to information or services not managed by us (such as your doctor or retail pharmacy) contact that provider directly.

If you are unable to find the form you need or have questions, call customer service at the telephone number located on the ID card for your health or pharmacy benefit plan.

Get It

You can ask to see or get a copy of your PHI.

Read More

Change It

You can ask to change or update your PHI if you think something is missing or incomplete. You can ask to receive mail or phone calls at locations other than your home.

Read More

Share It

You can assign someone to share your information with, or you can choose not to share it.

Read More

Monitor It

You can learn if your PHI has been shared for purposes outside of treatment, payment, or healthcare operations. You can report a privacy complaint.

Read More