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                Get Authorized Relative Certification Form
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How to fill out the Authorized Relative Certification Form online
Filling out the Authorized Relative Certification Form online is a straightforward process designed to confirm your relationship to a deceased individual. This guide provides step-by-step instructions to ensure you complete the form accurately and efficiently.
Follow the steps to complete the form correctly.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
 - In the first field, enter your name as the authorized relative of the deceased. Ensure that you fill in both your first and last name clearly.
 - Next, provide the name of the deceased in the designated field. Again, be thorough in including both the first and last name.
 - Attach a certified copy of the death certificate of the deceased. This is an essential requirement for submitting the form.
 - In the certification section, affirm that to the best of your knowledge, no executor or administrator has been appointed for the deceased’s estate, and confirm that there are no objections to disclosure.
 - Indicate your relationship to the deceased by checking the appropriate box, selecting either ‘Surviving spouse’ option or one of the listed relationships (adult son or daughter, parent, or adult sibling).
 - Finally, date the form in the specified area, and print your name and sign as the authorized relative at the bottom.
 - After completing the form, you can save changes, download, print, or share the form as needed.
 
Complete your documents online with confidence today!
Answer: Yes, for a period of 50 years following the date of death of the individual. During this period, the Privacy Rule protects the identifiable health information of the deceased individual to the same extent the Rule protects the health information of a living individual.
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