Connecticut Personal Representative Request Form

Category:

Confidentiality and Nondisclosure - HIPAA

State:

Multi-State

Control #:

US-3578

Format:

Instant download

Description

This form is used by a health plan to identify a representative of a subscriber who has legal authority to make health care decisions for the subscriber, such as a guardian, person appointed in a power of attorney, or other documented authority.

Connecticut Request for an Individuals Health Information

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Connecticut Request for Accounting of Disclosures of Protected Health Information

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Connecticut Request for Restrictions on Uses and Disclosures of Protected Health Information

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Connecticut HIPPA Violation Report Form

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Connecticut Confidential Data Form

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Aggressive Clause Dealing with Reentry and...

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Employee Cell Phone Usage Policy

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Plaintiff's Motion for Partial Summary Jud...

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Application for Reservation of Name

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Continuing and Unconditional Guaranty of B...

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Mediator Application

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Employment or Work Application - General

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Instructions for Notice of Need to File Pr...

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Change of Address (Attorney/ECF)

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Assignment, Assumption and Consent Agreeme...

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