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You can view and print forms online by accessing the links below. Simply click on the name of the form to view or download (print) a copy. Please call 1-800-MEDICARE (1-800-MEDICARE) for assistance filling out these forms. TTY users should call 1-877-486-2048. All of the forms are Adobe Acrobat version 7.0.5 accessible. You will need Adobe Reader software to view the files. Download Adobe Acrobat Now!Please note that CMS Form 10106, Medicare Authorization to Disclose Personal Health Information, can be completed and printed using Adobe Acrobat Reader. You have the ability to enter your information and then print the form to be mailed in. If you are signing this form as a personal representative (for example, Power of Attorney) for the person with Medicare, you are attesting that you have the legal authority to sign this document on their behalf. CMS reserves the right to request copies of the documentation or you must submit the documentation upon request. If you have questions, please contact 1-800-MEDICARE (1-800-633-4227).
*To view the Spanish version of this form, click on the 'Vea en Español' link at the top of the page.
A list of all CMS forms can be found at http://www.cms.hhs.gov/CMSForms/CMSForms/list.asp Page Last Updated: November 24, 2008
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