I am electronically providing my signature indicating that I hereby authorize and request that my treating physicians, healthcare professionals, or other healthcare providers disclose and transmit my protected health information in electronic form to Biohaven and/or its designated service providers in order for Biohaven to provide me, or my physician, with communications about benefits verification, my insurance plan's coverage status of prescribed Biohaven medications, Biohaven's...
I am electronically providing my signature indicating that I have read and understood the patient authorization above, that I am legally authorized to consent, and that I am providing my consent as the patient or patient's legal guardian for Biohaven to use and share personal information I or my Healthcare Providers provide for the purposes described within this authorization.
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