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Get Blue Cross Blue Shield Of Illinois Standard Authorization Form

Ase of his or her protected health information (PHI) to a specific person or entity. Please follow the instructions below for completing the Blue Cross Blue Shield of Illinois (BCBSIL) Standard Authorization Form to Use or Disclose Protected Health Information (PHI). If you need assistance in completing the authorization form, please call the Customer Service number listed on the back of your BCBSIL Membership Identification card. Please remember: One authorization form can be used for a ran.

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