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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICESForm Approved OMB No. 09380950APPOINTMENT OF REPRESENTATIVE Name of Party Medicare Number (beneficiary as party) or
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What is appointment of representative?
The appointment of representative is a legal document that designates a person or entity to act on behalf of another in a specific matter or situation.
Who is required to file appointment of representative?
Individuals or entities who want to authorize someone to represent them in legal, financial, or other important matters may be required to file an appointment of representative.
How to fill out appointment of representative?
To fill out an appointment of representative, you need to provide information about the appointer, the representative, the scope of representation, and any other relevant details.
What is the purpose of appointment of representative?
The purpose of appointment of representative is to formally authorize someone to act on your behalf in specific situations where you may not be able to do so yourself.
What information must be reported on appointment of representative?
The appointment of representative must include the names and contact information of both the appointer and the representative, as well as details about the scope of representation and any specific instructions.
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