CASE MANAGER PERMISSION FORM
Complete Case Management is one of our most valued services that we can offer you at Elevated Health NYC. We work to get your case approved at no cost to you. Your Case Manager (CM) may need to reach out to others regarding your case at various times throughout the case approval process. Please indicate below who you grant us permission to contact on your behalf:
Please review and initial the following statements where applicable:
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Please indicate anyone else that you would like to give us permission to discuss your case with:
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Please sign your name in the area below
By submitting your signature, the parties agree that this agreement may be electronically signed. The parties agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability, and admissibility.