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Authorization for 1215 East Michigan Avenue Disclosure of

Authorization for 1215 East Michigan Avenue Disclosure of-2025

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The document is an authorization form for the disclosure of protected health information (PHI) from Sparrow Health System. It allows patients to specify what personal health information can be shared, with whom, and for what purposes, including marketing and fundraising. The form outlines the types of information that may be disclosed, the means of receiving this information, and the patient's rights regarding revocation of consent.

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Versions	Form popularity	Fillable & printable
2016	4.5 Satisfied (54 Votes)
2014	4.8 Satisfied (59 Votes)

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