Sfn 1059-2025

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The document is an 'Authorization to Disclose Information' form from the North Dakota Department of Human Services, outlining the process for clients to authorize the release of their personal and health information. It includes a privacy statement regarding the voluntary disclosure of social security numbers, instructions for completing the form, and sections for client consent and signatures. The document also contains specific notices related to the confidentiality of addiction records under federal law.

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