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Get and Sign the ISU Department of Athletics Requires Verification of Primary Personal Health Insurance 2020-2022 Form

Get and Sign the ISU Department of Athletics Requires Verification of Primary Personal Health Insurance 2020-2022 Form

Use a The ISU Department Of Athletics Requires Verification Of Primary Personal Health Insurance 2020 template to make your document workflow more streamlined.

Policy is IN EXCESS or SECONDARY to any other collectible group or individual policy benefits. Date If student-athlete is under 18 years of age Parent s/Guardian s Signature AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION Patient name authorizes the release of protected health information PHI including insurance claims information and medical information for the processing of medical claims from health care providers and student-athlete s primary and if applicable secondary health...
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