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Personal Representative for Interoperability Removal

When a personal representative for interoperability is removed, they will no longer have access to the Wellmark member's information or be able to manage applications that use the member's health information.

As the member, you have the right to remove your personal representative or they may remove themselves.

Understand and agree

I understand that I may revoke this appointment and authorization at any time by giving written or electronic notice of my revocation to Wellmark Blue Cross and Blue Shield. I understand that revocation of this appointment and authorization will not affect any action taken in reliance on this appointment and authorization before Wellmark receives my written notice of revocation.