protected health information form

Description
Authorization for Disclosure of Protected Health Information I hereby authorize CIGNA HealthCare *, its agents or subsidiaries to disclose the Protected Health Information (PHI) indicated below to the persons or entities specified on this form. Please Note: This form is not required for all releases of your PHI. For example, this form may not be required to release information to: A spouse of a Customer, when both...
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protected health information form
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