Please complete this form to revoke your authorization for the release of your Protected Health Information (PHI). You may print and mail or fax a copy of this form to:
PO Box 161020
Salt Lake City, UT 84116
To authorize the release of information, please click HERE for the authorization form.
If you have any questions, please contact the UP Health Member Services team at 800-547-0421, Monday through Friday, 7:30 a.m. to 3:30 p.m., MST (TTY/TDD call the national number 711).