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el Authorization for the Release of Medical Information By signing this form, I either wish to file a complaint, or I authorize a health care provider to file a complaint on my behalf, with the Health Education and Advo
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Document Date: 2011-02-10 09:42:34


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File Size: 75,84 KB

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Company

HMO / /

IndustryTerm

insurance carriers / insurance information / insurance carrier / /

Organization

Health Education and Advocacy Unit / Maryland Insurance Administration / Federal government / /

Position

personal representative / Attorney General / /

ProvinceOrState

Maryland / /

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