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Enter the Humana member’s information
Remember, the following information is for the Humana member. The Power of Attorney will act on this person's behalf.
Member contact info
Enter the appointee’s information
Remember, the following information is for the person or organization appointed as Power of Attorney for a Humana member.
Is the appointee an
Upload Power of Attorney form
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Files must be in PDF, JPG, PNG or TIF format.