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AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION SECTION 1: MEMBER INFORMATION Member last name Member first name Member date of birth Member street address City State ZIP Code Member phone
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How to fill out member last name?

01
Start by locating the designated field for the last name in the form or application you are filling out.
02
Enter the member's last name accurately and correctly in the provided space. Make sure to double-check the spelling and avoid any typos.
03
If the member has a hyphenated last name, include both parts without any spaces or punctuation marks. For example, if the last name is "Smith-Jones," enter it as "Smith-Jones."
04
If the member has a suffix such as Jr., Sr., III, etc., include it immediately after the last name without any additional spaces. For example, if the last name is "Johnson" and the member is a junior, enter it as "Johnson Jr."
05
Double-check the accuracy of the entered last name before submitting the form or application.

Who needs member last name?

01
Organizations and institutions that require individual identification often need the member's last name. This can include government agencies, educational institutions, healthcare providers, and employers, among others.
02
Businesses and service providers often require the member's last name for record-keeping purposes, especially when dealing with transactions, contracts, or customer profiles.
03
It is essential for legal and official documentation, such as passports, driver's licenses, and birth certificates, to accurately record the member's last name.
04
Family records and genealogical research also depend on the member's last name for tracking ancestry and creating family trees.
05
In cases of emergency or medical situations, the member's last name becomes crucial for identification and contact purposes.
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Member last name is the surname or family name of an individual.
The individual or entity responsible for collecting personal information or maintaining records of individuals is required to file member last name.
Member last name should be filled out by entering the individual's surname in the designated space provided.
The purpose of member last name is to accurately identify individuals and maintain proper records.
The information reported on member last name includes the last name or family name of the individual.
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