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InstructionsforRequesting a Copy of your Health Record
* This Authorization for Release of Health Information and Confidential HIV-Related Information form is HIPAA compliant. If releasing only non-HIV related.
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doh-2557.pdf
This form authorizes release of health information including HIVrelated information. You may choose to release only your nonHIV health information,
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CH. 70.02. Medical RecordsHealth Care Information Access and
(f) The test results of voluntary and anonymous HIV testing or HIV I recognize that unauthorized release of confidential information may subject me to civil
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