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How to fill out the Medical School Residents And Fellows Cancellation Form - Office Of ... online
Filling out the Medical School Residents And Fellows Cancellation Form is an essential step for residents and fellows who wish to cancel their health coverage. This guide provides a clear, step-by-step approach to completing the form online, ensuring you understand each requirement.
Follow the steps to successfully complete the cancellation form.
- Click the ‘Get Form’ button to retrieve the cancellation form and open it in the document editor.
- In the first section labeled 'Resident/Fellow Information', enter your personal details. Include your name (last, first, middle initial), date of birth in the format mm/dd/yyyy, University of Minnesota ID number, and Social Security number. Provide your current street address, city, state, and ZIP code, along with your daytime phone number and email address.
- Proceed to the 'Cancellation Information' section. Here, indicate which types of coverage you wish to cancel by checking the relevant boxes. Note that if you intend to cancel HealthPartners coverage, you must also submit the Health Plan Waiver Request form.
- In the 'Enrollment Information' section, you need to list all individuals whose coverage you would like to cancel. Specify if the cancellation applies to you, your spouse or same-sex domestic partner, or any children. Include their names, date of birth, gender, and Social Security numbers as required.
- Complete the 'Resident/Fellow Authorization' section. This includes your signature and the date on which you signed the form. This authorization allows the university to manage medical information related to your cancellation request.
- Review all the information provided for accuracy before finalizing the form. Once you are satisfied, you can save changes, download the completed form, print it for your records, or share it as needed.
Take action today by completing the Medical School Residents And Fellows Cancellation Form online.
To file a complaint with ACGME, start by visiting their website for detailed procedures. Prepare your documentation and clearly state your concerns, using the online submission form provided. By understanding this process, you can ensure your concerns are heard effectively, particularly when issues arise related to the Medical School Residents And Fellows Cancellation Form - Office Of ....
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