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HIPAA Release Form Mail or fax completed forms to: Address: HealthEquity, Attn: Member Services 15 W Scenic Point Dr, Ste 400, Draper, UT 84020 Fax: 801.727.1005 Authorization to Release Protected
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Dependents must complete this form to provide their personal information and confirm their relationship with the taxpayer.
Any taxpayer who has eligible dependents, such as children or other qualifying individuals, is required to have them complete this form.
Dependents can fill out this form by providing their personal information, such as their name, date of birth, Social Security number, and any other required details. They may also need to confirm their relationship with the taxpayer.
The purpose of this form is to ensure that the dependents claimed by the taxpayer meet the necessary criteria and to report their information accurately for tax purposes.
Dependents must report their personal information, such as their name, date of birth, Social Security number, and any other required details. They may also need to provide additional information to confirm their relationship with the taxpayer.
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