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Other Forms

Centralized Process for
Representative Appointment
Attorneys'
Fee Dispute

Authorization for Release of Claims Information (Appendix A)
Request for Change in Representation Status
Substitution of Representative Claimant Form
BAP HIPAA Form

Authorization for Release of Claims Information (Appendix A)

Request for Change in Representation Status

BAP HIPAA Form

Substitution of Representative Claimant Form

Withdrawal of Attorney's Lien Dispute Form

Most Viewed Forms

Claim Form for Retired NFL Football Players and Representative Claimants

Pre-Effective Date Diagnosing Physician Certification Form

MAF Diagnosing Physician Certification Form

Authorization for Release of Claims Information (Appendix A)

Employment History and Social and Community Activity of Retired NFL Football Player (Form for Use by Retired Player)

Employment History and Social and Community Activity of Retired NFL Football Player (Form for Use by Knowledgeable Informant)

BAP HIPAA Form

 

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