Kansas 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.

Kansas Request for an Individuals Health Information

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Kansas Request for Accounting of Disclosures of Protected Health Information

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

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Kansas HIPPA Violation Report Form

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Kansas Confidential Data Form

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