Request for Appointment of Legal Personal Representative for Member

Request for Appointment of Legal Personal Representative for Member

Use this form to let another person handle your health care needs which includes full access to your personal health information, changes to your health care coverage, as well as receiving your health care mail.

ID: #40014 (0820)

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Braven Health is New Jersey born and raised. We know New Jersey health care, and we’ll be your guide to everything our top health systems have to offer. We’re looking out for New Jersey families, finding ways to get better care to more people and improve the overall health of our great state.