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This version of the form is not currently in use and is provided for reference only. Download this version of
Form EBD-543
for the current year.
Form EBD-543 Authorization for Release of Health Information - New York State Health Insurance Program (Nyship) - New York
What Is Form EBD-543?
This is a legal form that was released by the New York State Department of Civil Service - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is Form EBD-543?
A: Form EBD-543 is the Authorization for Release of Health Information specifically for the New York State Health Insurance Program (NYSHIP) in New York.
Q: What is the purpose of Form EBD-543?
A: The purpose of Form EBD-543 is to authorize the release of health information related to an individual's participation in the New York State Health Insurance Program (NYSHIP).
Q: Who needs to fill out Form EBD-543?
A: Individuals who are enrolled in the New York State Health Insurance Program (NYSHIP) and need to authorize the release of their health information must fill out Form EBD-543.
Q: Are there any fees associated with Form EBD-543?
A: No, there are no fees associated with Form EBD-543. It is a free form provided by the New York State Health Insurance Program (NYSHIP).
Form Details:
- Released on March 1, 2017;
- The latest edition provided by the New York State Department of Civil Service;
- 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 fillable version of Form EBD-543 by clicking the link below or browse more documents and templates provided by the New York State Department of Civil Service.
Download Form EBD-543 Authorization for Release of Health Information - New York State Health Insurance Program (Nyship) - New York
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