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Form PSRS-248-4 Poa Relationship Affidavit - Pennsylvania
What Is Form PSRS-248-4?
This is a legal form that was released by the Pennsylvania Public School Employees' Retirement System - a government authority operating within Pennsylvania. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form PSRS-248-4?
A: Form PSRS-248-4 is the Poa Relationship Affidavit used in Pennsylvania.
Q: What is the purpose of Form PSRS-248-4?
A: The purpose of Form PSRS-248-4 is to establish the relationship between the power of attorney (POA) holder and the healthcare representative appointed under the Pennsylvania Patient Self-Determination Act (PSDA).
Q: Who needs to fill out Form PSRS-248-4?
A: The power of attorney (POA) holder and the healthcare representative appointed under the Pennsylvania Patient Self-Determination Act (PSDA) need to fill out Form PSRS-248-4.
Q: Is Form PSRS-248-4 specific to Pennsylvania?
A: Yes, Form PSRS-248-4 is specific to Pennsylvania and is used to comply with the state's regulations.
Q: Are there any fees associated with Form PSRS-248-4?
A: No, there are no fees associated with Form PSRS-248-4.
Q: How should Form PSRS-248-4 be completed?
A: Form PSRS-248-4 should be completed by providing accurate information about the power of attorney (POA) holder and the healthcare representative.
Q: What should I do after completing Form PSRS-248-4?
A: After completing Form PSRS-248-4, you should keep a copy for your records and provide copies to the power of attorney (POA) holder, the healthcare representative, and any relevant healthcare facilities.
Q: Can Form PSRS-248-4 be used for any other purpose?
A: No, Form PSRS-248-4 is specifically designed for establishing the relationship between the power of attorney (POA) holder and the healthcare representative as required by the Pennsylvania Patient Self-Determination Act (PSDA).
Form Details:
- Released on July 1, 2019;
- The latest edition provided by the Pennsylvania Public School Employees' Retirement System;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of Form PSRS-248-4 by clicking the link below or browse more documents and templates provided by the Pennsylvania Public School Employees' Retirement System.
