Form 5006-2025

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4.8 out of 5

47 votes

The document is a Medical Record Authorization for Disclosure of Information form, which allows patients to authorize the release of their medical information to specified individuals or organizations. It outlines the conditions under which information can be disclosed, including restrictions and purposes for use, while emphasizing that it does not apply to alcohol or drug abuse patient information. The form requires patient data, treatment details, and signatures for authorization.

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Versions	Form popularity	Fillable & printable
2003	4.8 Satisfied (47 Votes)

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