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Get Health Net Vf0415x021 2015-2024

Se of this form and how it will be used by Health Net Federal Services, LLC (Health Net), on behalf of the U.S. Department of Veterans Affairs (VA). AUTHORITY: Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576. PURPOSE: This form authorizes Health Net (or its Business Associate) to use or disclose your information to a third party and/ or to allow a third party to seek or change authorizations or appointments on your behalf as you designate below. This form does not allow a thir.

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