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Set your care team up for success

Your care team is more than just your doctors. If you have family or friends who help with your care, they’re part of your team too. It’s important for us to have the right forms on file so they can support you.

Here’s how to figure out which forms will give the permissions you want:

Protected Health Information (PHI) sharing

This form gives permission for Devoted to speak with someone you trust about your plan benefits and your care. 

Fill out a PHI form online

Download a paper PHI form

Appointment of Representative (AOR)

This form gives permission for someone you trust to:

  • File appeals, grievances, and organization determinations on your behalf
  • Receive limited PHI (only related to appeals, grievances, and organization determinations)

Learn more about AOR

Download an AOR form

Medical power of attorney 

This form is also called a healthcare proxy or healthcare surrogate form. It's often set up so it's only active if a doctor determines that you're unable to make your own healthcare decisions. 

If this form is active, it gives permission for someone you trust to:

  • Receive your PHI
  • Book medical visits for you
  • Change your PCP
  • Consent to healthcare on your behalf

To set up a medical power of attorney, you can:

Durable general power of attorney

This is a legal document that gives someone the authority to act on your behalf in financial and legal matters. It can be written to give a wide range of permissions, or more limited permissions.

Depending how it's written, this form may give permission for someone you trust to:

  • Receive your PHI
  • File appeals, grievances, and organization determinations
  • Book medical visits for you
  • Change your PCP
  • Change your address or health plan enrollment
  • Give permission for others to receive your PHI

To set up a durable general power of attorney, you can:

  • Consult a lawyer
  • Get a form from your state

What if I already have documents set up?

That's great! If you have any of the documents above — or other legal documents like a guardianship or conservatorship — you can send a copy to us at:

Mail:
Devoted Health
PO Box 211127
Eagan, MN 55121

Fax: 1-877-264-3859

Please send only copies, not original documents. We will not be able to return any documents you send.


The information on this page is not legal advice. Using or relying on this information does not create an attorney-client relationship. Devoted Health is not liable for any actions you take or don’t take based on what is on this page.