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Get AL BCBS Form ENR-469 2015-2024

A and its business associate(s) on behalf of your Health Plan to disclose your health information that you describe below (”Protected Health Information”) to the persons or entities and for the purpose that you describe below. Please read and complete the following, and return to Blue Cross and Blue Shield of Alabama, PO Box 10485, Birmingham, Alabama 35202-0485. A. The Individual Who is The Subject of The Protected Health Information. Note: A separate authorization form must be completed b.

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