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Authorization to Disclose Protected Health InformationNotice to Member: Completing this form will allow California Health and Wellness Plan (CHIP) to share your health information with the person
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Completing this form will allow individuals to specify their final wishes regarding asset distribution and other important decisions.
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Completing this form will involves providing detailed instructions on how to distribute assets, designate guardians for minors, and make other important decisions.
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Information such as asset distribution, guardian designations, and funeral arrangements must be reported on completing this form will.
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