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I hereby authorize the UFCW Local 152 H&W (the “Fund”) to use and/or disclose my Protected Health.

UFCW LOCAL 152 Health & Welfare Fund Authorization Form. Indiana / Kentucky / Ohio Regional Council of Carpenters United Brotherhood of Carpenters and. Southwest Ohio Regional Council of Carpenters Pension. Southwest Carpenters Health & Welfare TrustBenefits & Pension.
