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Patient Financial Aid Form The only people allowed to fill out this form are patients, spouse/child, P.O.A., patient navigator or social worker at treatment center. Applications will not be accepted

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How to fill out financial power of attorney

01

Obtain a financial power of attorney form.

02

Choose an agent you trust to act on your behalf.

03

Fill out the form with your personal information and the agent's information.

04

Specify the powers you wish to grant to the agent.

05

Sign the form in front of a notary public to make it legally binding.

Who needs financial power of attorney?

01

Anyone who wants to designate someone to handle their financial affairs in case they become unable to do so themselves.

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What is financial power of attorney?

An authorization document that allows a designated person to make financial decisions on behalf of another individual.

Who is required to file financial power of attorney?

Any individual who wants to appoint someone to handle their financial matters in case they become incapacitated.

How to fill out financial power of attorney?

The form must be completed with the individual's personal information, the appointed person's information, and signed in the presence of witnesses or notary.

What is the purpose of financial power of attorney?

To ensure that someone can manage an individual's finances if they are unable to do so themselves.

What information must be reported on financial power of attorney?

Personal details of both the individual and the appointed person, financial institutions involved, and specific tasks the appointed person can handle.

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