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PHI form - English V.2 - Rogers Benefit Group 2025

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The document is a consent form for the release of protected health information (PHI) related to Humana's CoverageFirst PPO plan. It allows members to authorize the disclosure of their health information to designated individuals or organizations for assistance with their Humana plan. The form outlines the member's rights regarding revocation of consent, expiration of authorization, and potential redisclosure of information. It includes sections for member identification, recipient details, and legal representative requirements.

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2012	4.8 Satisfied (218 Votes)
2010	4.1 Satisfied (65 Votes)

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