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Printing E: FORMS CLIENT IBEW 092446 BENE FRP 2025

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The document is a request form for CIGNA Behavioral Health customers to receive communications of their protected health information (PHI) through alternative means or locations. It outlines the verification process, the implications of granting such requests, and the necessary identification details required from the customer. The form also includes sections for requesting restrictions on access to PHI by family members and requires notarization for privacy protection.

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