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File type: PDF
File page: 1 Page(s)
File size: 32KB
This Delaware Authorization for Use or Disclosure of Protected Health Information Form belongs to the Student Health Service of University of Delaware. This template possess the part of the personal information of the patient, the information of the recipient, the release content, the release reason, the release statement, and the signatures. We offer this file for free. If you are in need of this template, you can visit our website to get it.
This template of Authorization to Use/Disclose Protected Health Information has two pages, and the first page is the health information release form, and the second page is Instructions for Form Completion, which offers the detailed guidance for you. As for the health information release form, it is in a general format, which contains the part such as the patient's personal information, the recipient's information, the statement, and the release content. Also, this file is offered for free.
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