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To present or to elicit. Web the form must be signed by you and by the person whom you would like to act on your behalf. The ama disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in aetna clinical policy bulletins (cpbs). The completed and signed form is valid.
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The completed and signed form is valid for one (1) year. If your representative holds durable power of attorney or guardianship papers, an appointment of representative form is not required. I appoint the individual named in section 2 to act as my representative in connection with my claim or asserted right under title xviii of the social security act (the.
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