< Children's Health Insurance Program

Useful Forms

Member Authorization to Use or Disclose Protected Health Information Form that gives UPMC for Kids written permission to share protected health information	Personal Representative Designation Form Form by which the head of household gives a designated person written permission to discuss your child's health information and benefits with UPMC for Kids
Application - English UPMC for Kids application for CHIP health insurance in English	Application - Spanish Solicitud para el Programa de seguro médico para niños (CHIP) de UPMC for Kids en español.
Renewal App - English UPMC for Kids rewewal application for CHIP health insurance in English	Renewal App - Spanish Solicitud de renovación para el Programa de seguro médico para niños (CHIP) de UPMC for Kids en español.

< Children's Health Insurance Program