This form enables a beneficiary to authorize Health Net Federal Services, LLC (HNFS) or its subcontractor to release his or her medical information to a specified third party, for example, a spouse, relative or law firm.
Please note: Incomplete and/or unsigned forms will not be processed.
You may fax this form to 1-844-308-8877 or mail it to:
TRICARE Legal Documents
PO Box 8818
Virginia Beach, VA 23450-8818
- Created: Jun 6, 2018
- Modified: Jun 6, 2018
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