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Get Cms Medicare Authorization To Disclose Personal Health Information

Struction sheet when completing your “1-800-MEDICARE Authorization to Disclose Personal Health Information” Form. Be sure to complete all sections of the form to ensure timely processing. 1. Print the name of the person with Medicare. Print the Medicare number exactly as it is shown on the red, white, and blue Medicare card, including any letters (for example, 123456789A). Print the birthday in month, day, and year (mm/dd/yyyy) of the person with Medicare. 2. This section tells Medicare wha.

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