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CDCR 7385, Authorization for Release of Protected Health
Code 56.11(e), (f)]. The undersigned hereby authorizes CDCRs Health Information Management to release the health information pursuant to this authorization.
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member-phi-authorization-english.pdf
By completing and signing this form, I, or my legal representative, agree to allow Aetna to share my PHI with the people or companies listed below. By Aetna, I
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HIPAA Compliance: Microsoft Office 365 and
PHI includes information related to the past, present or future physical or mental health or condition of an individual; information about the provision of
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