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Request For Accounting Of Disclosures

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Request For Accounting Of Disclosures

This form must be completed when a member wants to request an accounting of disclosures of private information made by Braven Health. These will not include disclosures of private information made for purposes of treatment, payment or healthcare operations, disclosures to the member to whom the private information pertains, disclosures to a personal representative of the member, or as stipulated by federal or state privacy laws.