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Liveandworkwell com release of information form

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The document provides instructions for completing an Authorization for Release of Information form, which allows individuals to authorize Optum and its affiliates to disclose their health information. It outlines the necessary demographic information, the specific individuals or organizations authorized to receive the information, the types of information to be disclosed, and the purpose of the disclosure. The document also emphasizes the voluntary nature of the authorization, conditions regarding revocation, and includes sections for signatures and personal representatives.

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