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File type: PDF
File page: 2 Page(s)
File size: 32KB
This Wisconsin Medical Records Release Form has two pages. The first page is the release form, and the second page is the Additional Information Regarding Disclosure of Patient Health Information, which instructs the completing of the form. And the release form contains the part of Regarding Patient, Records Release From, Records Release To, Information to be Release, Purpose or Need for Disclosure, duration, legal statement and Signature. Also, this file is offered for free.
The Wisconsin Authorization to Release Protected Health Information contains a release authorization form and an Additional Information Regarding Release of Health Information. The authorization form has seven main parts, and they are patient's personal information, Authorization, To Release Protected Health Information to, Health Information to be Released, Purpose or Need for Disclosure, Explanation, and Signature. If you need it, you can get the free file from our website.
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