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Federal Employee Program (FEP) Claim Forms

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. To see all forms, please return to Forms Home Page.

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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Information Sheet

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Forms

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