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Purpose: I authorize the release of my health information for the following specific purpose: Only the following records or types of health information:
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Standard Authorization Of Use And Disclosure Protected
Standard Authorization Of Use And Disclosure Protected Health Information.pages AZ 8140 AAA To Release Medical Records. User Manual: AZ 8140.
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Authorization for the Release of Records to Another Individual
To ensure you receive the greatest possible access to documents, authorizations for all persons you are requesting records about should be received by this
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