隐私表格
作为 Blue Shield 的会员,您可使用以下表格,以行使有关 Blue Shield 所创建、获取和/或维护的您的相关健康信息方面的隐私权。
使用或披露健康信息的授权书
使用或披露健康信息的授权书, English (PDF, 102 KB)
使用或披露健康信息的授权书, Español (PDF, 102 KB)
使用或披露健康信息的授权书, Arabic (PDF, 190 KB)
使用或披露健康信息的授权书, Armenian (PDF, 133 KB)
使用或披露健康信息的授权书, Chinese (Simplified) (PDF, 164 KB)
使用或披露健康信息的授权书, Chinese (Traditional) (PDF, 424 K)
使用或披露健康信息的授权书, Farsi (PDF, 147 KB)
使用或披露健康信息的授权书, Hindi (PDF, 133 KB)
使用或披露健康信息的授权书, Hmong (PDF, 97 KB)
使用或披露健康信息的授权书, Khmer (Cambodian) (PDF, 120 KB)
使用或披露健康信息的授权书, Korean (PDF, 137 KB)
使用或披露健康信息的授权书, Russian (PDF, 177 KB)
使用或披露健康信息的授权书, Tagalog (PDF, 96 KB)
使用或披露健康信息的授权书, Vietnamese (PDF, 105 KB)
获取受保护健康信息 (PHI) 的申请书 (PDF, 90 KB)
修改受保护健康信息 (PHI) 的申请书 (PDF, 105 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书
有关受保护健康信息 (PHI) 的保密通信的申请书, English (PDF, 104 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Español (PDF, 85 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Arabic (PDF, 186 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Armenian (PDF, 108 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Chinese (Simplified) (PDF, 210 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Chinese (Traditional) (PDF, 244 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Farsi (PDF, 153 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Hindi (PDF, 135 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Hmong (PDF, 103 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Khmer (Cambodian) (PDF, 206 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Korean (PDF, 211 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Russian (PDF, 179 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Tagalog (PDF, 103 KB)
有关受保护健康信息 (PHI) 的保密通信的申请书, Vietnamese (PDF, 207 KB)
Request for Accounting Disclosures (PDF, 113 KB)
Request for Restriction (PDF, 115 KB)
Appointment of Representative form
Appointment of Representative form, English (PDF, 83 KB)
Appointment of Representative form, Español (PDF, 107 KB)
Appointment of Representative form, Arabic (PDF, 177 KB)
Appointment of Representative form, Armenian (PDF, 139 KB)
Appointment of Representative form, Cambodian (PDF, 128 KB)
Appointment of Representative form,Chinese (Simplified) (PDF, 245 KB)
Appointment of Representative form, Chinese (Traditional) (PDF, 322 KB)
Appointment of Representative form, Farsi (PDF, 156 KB)
Appointment of Representative form, Hindi (PDF, 141 KB)
Appointment of Representative form, Hmong (PDF, 141 KB)
Appointment of Representative form, Korean (PDF, 107 KB)
Appointment of Representative form, Russian (PDF, 179 KB)
Appointment of Representative form, Tagalog (PDF, 106 KB)
Appointment of Representative form, Vietnamese (PDF, 184 KB)
若要行使该等或任何其他隐私权,请拨打会员 ID 卡背面的会员服务部电话号码。
最后更新时间:2024年6月20日
语言援助
免費費語語言言服服務務。您可獲得口譯員服務。可以用中文把文件唸給您聽,有些文件有中文的版本,也可以把這些文 件寄給您。
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Cov Kev Pab Txhais Lus Tsis Them Nqi. Koj yuav thov tau kom muaj neeg los txhais lus rau koj thiab kom neeg nyeem cov ntawv ua lus Hmoob. Yog xav tau kev pab, hu rau peb ntawm tus xov tooj nyob hauv koj daim yuaj ID los sis 1-866-346-7198. Yog xav tau kev pab ntxiv hu rau CA lub Caj Meem Fai Muab Kev Tuav Pov Hwm ntawm 1-800-927-4357 Hmong
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Беслпатные услуги перевода. Вы можете воспользоваться услугами переводчика, и ваши документы прочтут для вас на русском языке. Если вам требуется помощь, звоните нам по номеру, указанному на вашей идентификационной карте, или 1-866-346-7198. Если вам требуется дополнительная помощь, звоните в Департамент страхования штата Калифорния
(Department of Insurance), по телефону 1-800-927-4357. Russian
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Các Dịch Vụ Trợ Giúp Ngôn Ngữ Miễn Phí. Quý vị có thể được nhận dịch vụ thông dịch. Quý vị có thể được người khác đọc giúp các tài liệu và nhận một số tài liệu bằng tiếng Việt. Để được giúp đỡ, hãy gọi cho chúng tôi tại số điện thoại ghi trên thẻ hội viên của quý vị hoặc 1-866-346-7198. Để được trợ giúp thêm, xin gọi Sở Bảo Hiểm California tại số 1-800-927-4357. Vietnamese
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Անվճար Լեզվական Ծառայություններ։ Դուք կարող եք թարգման ձեռք բերել և փաստաթղթերը ընթերցել տալ ձեզ համար հայերեն լեզվով։ Օգնության համար մեզ զանգահարեք ձեր ինքնության (ID) տոմսի վրա նշված կամ 1-866-346-7198 համարով։ Լրացուցիչ օգնության համար 1-800-927-4357 համարով զանգահարեք Կալիֆորնիայի Ապահովագրության Բաժանմունք։ Armenian
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
無料の言語サービス 日本語で通訳をご提供し、書類をお読みします。サービスをご希望の方は、IDカー ド記載の番号または1-866-346-7198までお問い合わせください。更なるお問い合わせは、カリフォルニア州保険庁、1-800-927-4357までご連絡ください。Japanese
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Servicios de idiomas sin costo. Puede obtener un intérprete. Le pueden leer documentos y que le envíen algunos en español. Para obtener ayuda, llámenos al número que figura en su tarjeta de identificación o al 1-866-346-7198. Para obtener más ayuda, llame al Departamento de Seguros de CA al 1-800-927-4357. Spanish
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
免費語言服務。您可獲得口譯員服務。可以用中文把文件唸給您聽,有些文件有中文的版本,也可以把這些文 件寄給您。欲取得協助,請致電您的保險卡所列的電話號碼,或撥打 1-866-346-7198 與我們聯絡。欲取得其他協助,請致電 1-800-927-4357 與加州保險部聯絡。Chinese
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
무료 통역 서비스. 귀하는 한국어 통역 서비스를 받으실 수 있으며 한국어로 서류를 낭독해주는 서비스를 받으실 수
있습니다. 도움이 필요하신 분은 귀하의 ID 카드에 나와있는 안내 전화: 1-866-346-7198번으로 문의해 주십시오. 보다 자세한
사항을 문의하실 분은 캘리포니아 주 보험국, 안내 전화 1-800-927-4357번으로 연락해 주십시오. Korean
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Walang Gastos na mga Serbisyo sa Wika. Makakakuha ka ng interpreter o tagasalin at maipababasa mo sa Tagalog ang mga dokumento. Para makakuha ng tulong, tawagan kami sa numerong nakalista sa iyong ID card o sa 1-866-346-7198. Para sa karagdagang tulong, tawagan ang CA Dept. of Insurance sa 1-800-927-4357 Tagalog
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
บริการทางภาษาอย่างไม่เสียค่าใช้จ่าย คุณสามารถรับบริการจากล่าม รวมถึงให้เจ้าหน้าที่อ่านเอกสารให้คุณฟัง
หรือส่งเอกสารบางส่วนในภาษาของคุณไปหาคุณได้ หากต้องการความช่วยเหลือ
กรุณาโทรศัพท์ตามหมายเลขที่ระบุอยู่ด้านหลังบัตรประจําตัวของคุณ หรือ ที่หมายเลข 1-866-346-7198
หากต้องการความช่วยเหลือเพิ่มเติม โปรดโทรมาที่ กรมการประกันภัยแห่งมลรัฐแคลิฟอร ์เนียที่หมายเลข 1-800-927-4357 Thai
Language assistance
Blue Shield provides document and telephone support in a variety of languages, so that getting services is easier.
You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.