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Authorization Form Page

If you have a child, spouse or other dependent on your plan who is older than age 18, we cannot speak to you about this person’s care unless the person signs the “Authorization for Release of Health Information — Standing” form allowing us to do so. Likewise, if you are a caregiver for a USFHP member, the member must provide authorization for USFHP to speak with you.

Ask your child, dependent or individual for whom you care to print, fill out and sign the form, and either mail or fax it to us. Our mailing address and fax number are on the second page of the form.

Download the Authorization form

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