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All plans offered and underwritten by Kaiser Foundation Health Plan of the Northwest. 500 NE Multnomah St. Suite 100 Portland OR 97232. Please complete sign and date below. I authorize the following individual to act as the producer of record for purposes of arranging and servicing health care coverage with Kaiser Foundation Health Plan of the Northwest for the company s employees and dependents. X Employer signature Date Note Attach a copy of the bill of sale 317SBG-13/8-13 2013 Kaiser...
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