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Authorization to Release of Confidential Information
By signing this form I understand that I am authorizing the Counseling and Wellness Center to use and/or disclose my protected health information (PHI) as
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Request for Confidential Filing of Address
Sep 30, 2021 Request for Confidential Filing of Address. Form Number. 12.980(h). Form Type. Domestic, Repeat, Sexual or Dating Violence; Stalking. Date.
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501.171. Security of confidential personal information.
May 12, 2020 501.171. Security of confidential personal information. Country/Jurisdiction, United States. State or Province, Florida. Regulatory Bodies.
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