As a Bienvivir All-Inclusive Senior Health visitor (prospective program enrollee), participant, or designated representative, you have the right to exercise your privacy rights regarding the health information that Bienvivir All-Inclusive Senior Health creates, obtains, and/or maintains about you. To do so, you may use the forms provided below. All forms are available in PDF format.

• Authorization for Bienvivir to Share Health Information
• Request to Restrict Sharing of Health Information
• Request to Cancel Restrictions on Sharing of Health Information
• Request to Revoke Authorization to Share Health Information
• Authorization for Bienvivir to Request Health Information for a Prospective Program Enrollee
• Request to Release Health Information

Forms must be signed with a wet signature before submission. Once completed, please submit the form to Bienvivir All-Inclusive Senior Health either in person to your Social Worker or through one of the following methods

Mail:
Bienvivir All-Inclusive Senior Health
Medical Records Department
656 Rancho Alegre Way, El Paso, TX 79915

Fax:
For Carolina Participants: (915) 875-8863
For Concourse Participants: (915) 875-8821
For McKinley Participants: (915) 875-8847