This notice describes how medical information about you, as a Blue Shield of California Promise Health Plan member, may be used and disclosed, and how you can access your information. 

Download the full Notice of privacy practices (PDF, 191 KB)

Privacy forms

Use this form to authorize Blue Shield of California Promise Health Plan to use or to disclose your health information to another person or organization:

Authorization for the Use or Disclosure of Health Information, English (PDF, 296 KB)
Authorization for the Use or Disclosure of Health Information, Chinese (PDF, 403 KB)
Authorization for the Use or Disclosure of Health Information, Hindi (PDF, 450 KB)
Authorization for the Use or Disclosure of Health Information, Korean (PDF, 546 KB)
Authorization for the Use or Disclosure of Health Information, Spanish (PDF, 298 KB)
Authorization for the Use or Disclosure of Health Information, Vietnamese (PDF, 498 KB)