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Get Authorization Form Health Insurance Portability - Nyc . Gov - Nyc

K, N.Y. 10006 Tel: (212) 306-7760 TTY: (212) 306-7629 Please Read: We are unable to speak to anyone other than the participant about personal information or claims unless we have an authorization on file. If you would like to authorize a person to receive private information, please fill out this form. In order for the authorization to be valid, you must sign and fill out the form completely. You must list the specific person or organizations you are authorizing in Section II. Also, you must pr.

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