Get Cigna Medical Power Of Attorney Form

Filling out the Cigna Medical Power Of Attorney Form online is an important step in ensuring your medical preferences are honored. This guide provides detailed, user-friendly instructions to help you complete the form easily and accurately.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter your personal identification information, including your name, date of birth, and address. Ensure that all fields marked as required are completed accurately.
3. Provide your phone number to allow for contact during the processing of your request.
4. If applicable, fill out the RESTRICTION section to indicate if you are revoking or changing privacy restrictions. Provide the specific details required.
5. Complete the CONFIDENTIAL COMMUNICATIONS section if you have an active communications address on file. State whether you wish to revoke or change this address and provide the necessary updates.
6. In the PERSONAL REPRESENTATIVE section, indicate if you are revoking or changing the Personal Representative's information, then update the required fields.
7. Fill out the PRIVACY AUTHORIZATION REQUEST section only if you have an active authorization on file. Indicate if you wish to revoke this authorization and provide necessary details.
8. If applicable, complete the STATEMENT OF DISAGREEMENT section to indicate if you wish to revoke any previously submitted disagreements.
9. Sign and date the form, ensuring that the appropriate section (A or B) is completed based on your request type.
10. After completing the form, review all the information for accuracy. Once satisfied, you can save changes, download, print, or share the completed form.

Start filling out your Cigna Medical Power Of Attorney Form online today to ensure your medical desires are respected.