Anthem BlueCross Member Authorization Instructions and Form. Anthem BlueCross Member Authorization Instructions and Form 2026

1. Click ‘Get Form’ to open the Anthem BlueCross Member Authorization Instructions and Form in the editor.
2. In Part A, provide your member information. Fill in your last name, first name, middle initial, date of birth (mm/dd/yyyy), full address, daytime phone number, identification number, and group number as found on your member ID card.
3. Move to Part B to specify the person or company receiving your information. Check the appropriate box and enter their full name. Avoid general terms like 'my daughter' or 'my son'.
4. In Part C, indicate what information can be released. Choose between all information or limited information by checking the relevant boxes.
5. Part D requires you to state the purpose of this approval. Check the box that applies to your situation.
6. In Part E, select when you want this approval to expire—either one year from signing or an earlier specified date.
7. Finally, sign and date in Part F. Ensure your signature matches the name provided in Part A.

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