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Fill and Sign the Notification of Sale Transfer or Assignment in Bulk Form

Fill and Sign the Notification of Sale Transfer or Assignment in Bulk Form

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MUTUAL OF OMAHA PRIVACY NOTICE—MEDICAL INFORMATION ATTACHMENT FOR RESIDENTS OF IOWA HIV/AIDS-Related Tests: We may not obtain an HIV test Authorizations: If we request an authorization it will of any individual in connection with an application for insurance unless the individual to be tested provides to us a release form in compliance with Iowa law. include the identity of the individual, and it shall not remain valid for longer than twenty-four (24) months. An authorization may be revoked at any time subject to the rights of an individual who acted in reliance on the authorization before notice of the revocation. Membership List: Except to the extent permitted under Iowa law, a health maintenance organization is prohibited from releasing the names of its membership list. MC20368_IA

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