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REQUEST FOR AND AUTHORIZATION TO RELEASE PROTECTED HEALTH INFORMATION TO HEALTH INFORMATION EXCHANGES Privacy Act Information: The execution of this form does not authorize the release of information other than that spec
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Document Date: 2016-12-16 11:09:06
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REQUEST FOR AND AUTHORIZATION TO RELEASE PROTECTED HEALTH INFORMATION TO HEALTH INFORMATION EXCHANGES Privacy Act Information: The execution of this form does not authorize the release of information other than that spec