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Get Mt Dphhs Hps-401 2013-2026
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How to fill out the MT DPHHS HPS-401 online
The MT DPHHS HPS-401 form is essential for designating an Authorized Personal Representative for managing your health information. This guide will provide user-friendly, step-by-step instructions on how to accurately complete this form online, ensuring you can effectively name a representative while protecting your privacy.
Follow the steps to fill out the MT DPHHS HPS-401 form online.
- Press the ‘Get Form’ button to access the form and launch it in your preferred editing tool.
- In the designation section, clearly print the name of the individual you wish to designate as your Authorized Personal Representative in the provided space.
- Determining the extent of the authority: You will see two options regarding the privileges of your representative. Choose one by checking the appropriate box. The first option grants full access to your health information, while the second limits access to specified functions—if you select the latter, ensure you list the specific functions clearly.
- Read and understand the statement provided, which informs you that you can cancel this designation at any time by using the revocation section of the form.
- Sign and date the form in the designated areas to confirm your designation of the personal representative.
- Review the completed form for accuracy to ensure all information is correct. Once reviewed, you can either save your changes, download the document, print it out, or share it as needed.
Complete your MT DPHHS HPS-401 form online today to ensure your health information is managed according to your preferences.
At apply.mt.gov, individuals can also create an online account. An online account allows individuals to update their contact information, renew their coverage when it's time, and receive correspondence. Call the Public Assistance Helpline at 1-888-706-1535.
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