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OB-GYN Health Center of Volusia, LLCPATIENT FORMS

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The document is an authorization form for the release of protected health information from Dedicated to Women OB-GYN, P.A. It includes sections for personal information of the individual whose records are being disclosed, details about the entity releasing and receiving the information, a description of the health information to be released, the purpose of the release, duration of authorization, fees for copying records, and certification and acknowledgment by the individual. The form ensures compliance with privacy regulations while facilitating the transfer of medical records.

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