Summit Health Privacy Center

Summit Health is committed to keeping both your personal and health information safe.

Website policies

We appreciate your use of our website and respect your private information. Learn more:

• Website privacy statement - access our privacy policy for this website
• Terms of use - review the terms and conditions for all users of this website

Summit Health and HIPAA

Summit Health adheres to the standards mandated by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. We do not share private health information unless authorized. Learn more:

• Notice of privacy practices (En Español) - describes how your health information may be used or shared and how you can get access to this information
• Interoperability - access our CMS Interoperability guidelines
• PHI disclosure authorization form (En Español) - this PHI authorization form is specific to Summit Health. By completing this form, you allow us to disclose certain health and claim information to the person whom you authorize. This form does not allow the authorized person to change or manage any of your account information (appeals, addresses, ID cards). For that type of Authorization, see Other Legal Documents below.
• Appointment of a Representative – this form is developed by the Department of Health and Human Services (DHS). By completing this form, you allow Summit Health to accept an appeal request, and to accept or provide appeals information, to the person of your designation. (Large print) (En Español)
• Advance Directive (En Español)– an Advance Directive is an optional form that allows you to communicate your healthcare preferences in case you are no longer able to make medical decisions because of a serious illness or injury. It is recommended that you complete this form and provide it to your health care providers.
• Confidential Communications Request Form (En Español)- form to request to have protected health information sent to you rather than the person who pays for your health insurance plan
• Other Legal Documents – legal documents such as a Court appointed Legal Guardian or Conservator, General Power of Attorney, Power of Attorney for Healthcare may allow other representatives to manage your Moda Health account, beyond what is allowed by the forms listed above (ex: updating your address, ordering an ID card, changing your PCP). These documents would need to be obtained through a lawyer.

Last updated: 19-May-2022