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AHP Injury Information Form

AHP Injury Information Form 2025

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The document is a HIPAA Protected Health Information (PHI) Release Form that allows patients to authorize the use or disclosure of their protected health information. It includes sections for patient details, guardian information (if applicable), specific PHI to be disclosed, and the organization responsible for releasing the information. The form outlines the patient's rights regarding revocation and expiration of the authorization, and it must be signed by the patient or their legal representative.

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