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Delta Dental cannot give Protected
Health Information over the phone to an employer
after April 14, 2003 without written authorization.
Employers can authorize their brokers
to receive PHI on their behalf for plan administration
activities by using the following forms:
- Employer Authorization Form A - PHI not limited
to enrollment or summary health information
 PDF
Format
 Word
Format
- Employer Authorization Form B - PHI limited
to enrollment or summary health information
PDF
Format
Word
Format
Individuals can authorize brokers, employers, or
others to receive PHI by using the following
form:
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