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FCW & Employers Trust Authorization Form If you want the FCW & Employers Trust (the Plan) to use and disclose your Protected Health Information (PHI) (or the PHI of a Participant you represent) in
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What is if you want form?
If you want form is a document used to request information or services.
Who is required to file if you want form?
Anyone who wants to request information or services may be required to file if you want form.
How to fill out if you want form?
To fill out if you want form, you need to provide your personal information and details of what you are requesting.
What is the purpose of if you want form?
The purpose of if you want form is to formally request information or services.
What information must be reported on if you want form?
You must report your name, contact details, and the specific information or services you are requesting on if you want form.
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