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Please include a detailed explanation and 2025

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82 votes

The document is a request form for patients to amend their protected health information (PHI) at UCLA Health. It requires patients to provide details about the information they wish to change, reasons for the request, and any relevant dates. The form outlines conditions under which UCLA Health cannot amend PHI and provides instructions for submission, including contact information for inquiries.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (82 Votes)
2014	4.3 Satisfied (116 Votes)

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