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AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION TO SUMC (VANDERBILT UNIVERSITY MEDICAL CENTER) PATIENT IDENTIFICATION Name: Date of Birth S.S.# Maiden/Other names known by: RELEASE RECORDS TO: (Physician

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What is authorization for release of?

Authorization for release of is a legal document that allows an individual or entity to disclose confidential information to a third party.

Who is required to file authorization for release of?

Any individual or entity that wishes to disclose confidential information to a third party is required to file authorization for release of.

How to fill out authorization for release of?

Authorization for release of can be filled out by providing the necessary personal information of the disclosing party, the recipient of the information, and the specific information that is being released.

What is the purpose of authorization for release of?

The purpose of authorization for release of is to legally grant permission for the disclosure of confidential information to a third party.

What information must be reported on authorization for release of?

The information that must be reported on authorization for release of includes the disclosing party's personal information, the recipient's information, and the specific information being released.

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