Personal information preference 2025

1. Click ‘Get Form’ to open it in the editor.
2. In Section B, enter your full name, physical street address, city, state, and zip code. If your mailing address differs from your physical address, provide that information as well.
3. Move to Section C where you will indicate your preferences regarding sharing personal health information. Select 'Yes' if you want Medicare to share your information or 'No' if you wish to decline sharing.
4. Sign and print your full name in the designated areas. If applicable, check the box indicating you are a personal representative and provide the necessary details.
5. Finally, refer to Section D for submission instructions. You can either return the form in person or via mail to Indiana University Health ACO, Inc., or call 1-800-MEDICARE for assistance.

Start using our platform today for free and take control of your personal health information preferences!