Get the free Completing this form will allow Ambetter from MHS to share your health information w...

Mail To Ambetter from MHS Attn Privacy Officer 1099 Meridian Street Suite 400 Indianapolis IN 46204 Phone 1-877-687-1182 TTY/TDD 1-800-743-3333 Revocation of Authorization to Disclose Health Information Keep this form and use it when you want to cancel your Authorization I want to cancel or revoke the permission I gave to Ambetter from MHS to share my health information with this person or group I understand that my health information may have already been shared because of the permission I...

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