INCAPACITATED ADULT REQUEST FORM

Requests on behalf of an incapacitated adult to exercise their rights under applicable state privacy laws must be submitted via this form.The form, with the requested documentation included, should be sent via U.S. Mail to the address below. For Right to Know/Access,Right to Correct, and Right to Delete requests, we’ll notify you via U.S. mail when we receive your request, and fulfillment may take upto 45 days. For all other requests, we do not notify you when we receive your request and fulfillment takes up to 15 days.