WTC Health Program HIPAA Authorization for Deceased Individuals

[NIOSH] World Trade Center Health Program Enrollment, Appeals & Reimbursement

OMB: 0920-0891

IC ID: 251018

Documents and Forms

Document Name Document Type
Form 0920-0891 WTC Health Program HIPAA Authorization for Deceased Individuals Form and Instruction
0920-0891 WTC Health Program HIPAA Authorization - Deceased Individuals App O WTCHP HIPAA Authorization for Deceased Individuals DRAFT.docx Form and Instruction
0920-0891 HIPAA Authorization for Disclosures Regarding Deceased Individuals App-O-WTCHP-HIPAA-Authorization-for-Deceased-Individuals-updated2024.pdf Form and Instruction
0920-0891 WTCHP HIPAA Authorization Deceased Individuals_10FEB2025 App N-WTCHP HIPAA-Authorization-for-Deceased-Individuals-updated2024.pdf Form and Instruction