The following forms may be filled out by patients of HME Specialists and submitted by mail, fax, or email using the contact information below. Please ensure that forms submitted to HME Specialists are filled out completely. If you are unsure of how to fill out the form please contact Customer Service for assistance.
HME Specialists
3901 Masthead St. NE
Albuquerque, NM 87113
Phone: 505-888-6500
Fax: 505-888-6505
Email: compliance@hmespecialists.com
Click link to download:
- HIPAA Authorization Request Form
- HIPAA Authorization Request Form Instructions
- HIPAA Authorization Request Form (Spanish)
- HIPAA Authorization Request Form Instructions (Spanish)
- Request to Inspect or Copy PHI
- Request to Inspect or Copy PHI (Spanish)
- Request to disclose PHI to specified party
- (Spanish HIPAA) Request to disclose PHI to specified party