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Physical / Occupational Therapy

The following forms will help you manage your healthcare information.

What you’ll need:

  • 10-15 minutes, and
  • In some cases, your health plan ID card

What would you like to do with the healthcare information we have about you?


Click here for a form you can download and return to request a copy of your healthcare information that Optum maintains.


Click here for a form you can complete to request a change to your healthcare information that Optum maintains.


Click here for a form you can complete to receive Optum correspondence at a confidential address. If this is an urgent request, call the phone number on the back of your health plan ID card to make a verbal request.


Click here for a form you can complete to change an existing confidential communication address.


Click here for a form you can complete to limit who your healthcare information is released to or how it is used. Optum uses and discloses member level information only as necessary to provide services to our members and as permitted and required by law. Please note that while we will try to honor your request and will permit requests consistent with our policies, we are not required to agree to any restriction.


Click here for a form you can complete to allow someone else to access your healthcare information or speak on your behalf.


Click here for a form you can complete to stop sharing your healthcare information with someone else.


Click here for a form you can complete to establish your authority to represent someone else. You will also need to provide a copy of your legal authority to represent the individual.


Click here for a form you can complete to obtain a list of who your information has been disclosed to for purposes outside of treatment, payment, or healthcare operations.


  • Via email at privacy@optum.com.
  • Via mail at:
    Optum
    Privacy Administrator
    MN101-E013
    11000 Optum Circle
    Eden Prairie, MN 55344
  • You may also notify the Secretary of the U.S. Department of Health and Human Services of your complaint. We will not take any action against you for filing a complaint.

  • If you are enrolled in an insured plan offered by Optum Physical Health, click here to obtain a copy of the NPP outlining how your healthcare information may be used and/or disclosed.
  • If you are enrolled in an insured plan offered by Optum Physical Health of California, click here to obtain a copy of the NPP outlining how your healthcare information may be used and/or disclosed.
  • If you are not enrolled in an Optum Physical Health plan, please contact your plan for a copy of its HIPAA NPP.

If you are unable to find the form you need or have questions, call the phone number on the back of your health plan ID card.