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Designated Representative Form Process

A Designated Representative (DR) form is a legal document allowing someone you trust (like a family member, friend, or advocate) to act on your behalf for specific tasks, most commonly related to healthcare (accessing records, discussing treatment, filing appeals) or insurance/benefits (handling claims, appeals, or enrollment), giving them formal authority to manage your information and communications with providers or agencies

When an agent sends in their Designated Representative Form, please complete the following:
  1. Reply to the agent letting them know that we have received their document.
  2. Attach it to a note in their HubSpot Contact record and Pin the note
  3. Save the file to their Sharepoint folder. 
  4. Close the ticket, Category: Account, Sub-Category: Designated Representative Notice

If an agent reaches out asking for the form, please send them this form: Designated Representative Form