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Consent for Release of Information - SSA-3288
Complete this form only if you want us to give information or records about you, a minor, or a legally incompetent adult, to an.
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Restricted Information Release Authorization
Please fill out the form below to request verification and authorization before sending any sensitive information to third parties. Restricted Information
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Authorization to Release Protected Health Information to a
Instructions: This form is to be used by a patient or legal representative to authorize the release of information to a third party (other than a family
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