Abp 1676 2-2025

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The document is an authorization form from the County of Los Angeles Department of Public Social Services, allowing the disclosure and use of protected health information for determining eligibility for benefits. It includes sections for patient information, facilities authorized to share health data, types of information to be disclosed, and rights regarding the authorization. The patient can revoke this authorization at any time.

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2014	4.7 Satisfied (61 Votes)

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