TennCare Forms and Agreements
English
- Business Associate Agreement
- Enrollee Request to Restrict Use and Disclosure of PHI
- Authorized Representative - Individual
- Authorized Representative - Organization
- HIPAA Permission to Release Records
- Form for Reporting Unauthorized Disclosures, Loss or Potential Loss of Protected Health Information (PHI) and/or Personally Identifiable Information (PII)
- Privacy Impact Assessment Threshold Analysis
- Privacy Impact Assessment
- Request to Amend
- Trading Partner Agreement
Espanol
- Autorización de organización representante de la División de Finanzas y Administración de Cuidado Médico de Tennessee
- Autorización de representante personal de la División de Finanzas y Administración de Cuidado Médico de Tennessee
- Permiso para divulgar Información Médica Amparada (IMA)
- Petición para enmendar expedientes médicos