Completing this form is one of the conditions necessary to receive funds from the City. The signer need not sign in the notary's presence but must personally appear before the notary and state that the signature on the document is his or hers.Be filled out in its entirety; 2. To get a document notarized, you need to find a notary public. Bring an Application for Authentication request to either the Springfield or Chicago Index Department office between 8 a.m. This form should be used when authorizing Blue Cross Blue Shield of Illinois to disclose an individual's Protected Health Information. Please carefully read the information below before completing this Letter of Authorization. It is in the public's interest that all relevant information concerning my personal and employment histories be disclosed to the CPD. Use this form to authorize Blue Cross Blue Shield of Illinois to disclose your protected health information (PHI) to a specific person or entity. Instructions to contact the Chicago Asylum Office via email and authorization form.

Authorization Letter With Signature In Chicago

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