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Authorization to Release Protected Health Information
□ COMPLETE MEDICAL RECORD I understand the information to be released may include records related to behavior and/or mental health care, alcohol and drug abuse
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Authorization for release of information
I hereby authorize and direct any hospital, physician or other person who has any information regarding my medical care and treatment during ,
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MINOR CONSENT TO MEDICAL TREATMENT LAWS
Parental authorization, or authorization from a person who may consent on behalf of the minor pursuant to RCW 7.70.065, is required for inpatient treatment
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