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The document is a Medical Authorization Form for students participating in various programs at Brown University. It requires students to provide personal and medical information, including insurance details, medical history, and emergency contact information. The form authorizes the university to obtain medical treatment for students under 18 years of age and outlines the responsibilities of parents/guardians regarding medical disclosures and liabilities.

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Versions	Form popularity	Fillable & printable
2014	4.8 Satisfied (276 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the phone number for Ohio State medical billing?

Who to call for billing questions. For questions related to billing at OSU Medicine Clinics, view your MyChart account or call OSU Medicine Clinic Financial Services at 918-561-5701. If your question relates to inpatient care at OSU Medical Center, please call OSU Medical Center Customer Service at 918-599-4500.

Whose phone number is 614 293 5000?

The Ohio State University Wexner Medical Center.

How do I reset my OSU Carelink password?

Step 1: Navigate to my.osu.edu. Step 2: Select forget your username? or forget your password? Step 3: Follow the instructions to reset your username or password.

What number is 614 293 5000?

Please note that OSU Wexner Medical Center uses 614-293-5000 for outbound calls only.

Where can I obtain more information about HIPAA at osu health system?

For additional information or if you do not have an OSUWMC login and cannot access the OUCI Privacy/HIPAA website, please contact the Privacy Office at 614-293-4477.

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What is a medical authorization form?

A HIPAA authorization form gives covered entities permission to use protected health information for purposes other than treatment, payment, or health care operations. Continue reading to find out when authorization to disclose health information is needed.

What is the phone number for HR connection Ohio State University?

HR Connection Phone and Fax Call (614) 247-myHR (6947), Monday-Friday, 8 a.m. to 5 p.m.; fax (614) 292-7813.

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What is the phone number for Ohio State medical billing?

Whose phone number is 614 293 5000?

How do I reset my OSU Carelink password?

What number is 614 293 5000?

Where can I obtain more information about HIPAA at osu health system?

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What is a medical authorization form?

What is the phone number for HR connection Ohio State University?

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