Tides consent1 DOCX 2025

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The document provides contact information for Tides Medical's Reimbursement Hotline, along with an intake form for physicians and facilities to submit patient information related to skin graft substitute procedures. It includes sections for physician, facility, and patient details, as well as insurance information and HIPAA authorization for sharing health information. The document emphasizes the importance of patient consent for releasing medical information and outlines the conditions under which Tides Medical can use this information.

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