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Get UPMC Personal Representative Designation Form 2012-2024

You return this completed, signed, and dated form to us, we can verify your request, adjust our records accordingly, and speak to your personal representative. Read this form carefully and then fill it out completely by printing or typing. If printing, use a pen. Note that, subject to the disclaimers in the following paragraph, this form can be used to document the following types of personal representative activities on behalf of the patient: Make appointments for health care serv.

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  1. Click on the orange Get Form button to start filling out.
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  5. Include the date to the document with the Date option.
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  8. Click Done in the top right corne to export the file. There are various options for receiving the doc. As an instant download, an attachment in an email or through the mail as a hard copy.

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