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RELEASE OF INFORMATION
TO BE COMPLETED BY PATIENT
Please list the family members, significant others, or other persons, if any, whom we may inform about
your general medical condition and your diagnosis.
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What is release of information?
Release of information is the process of providing specific details or documents to a designated individual or organization, typically with the consent of the individual to whom the information pertains.
Who is required to file release of information?
The individual or entity who possesses the information and is being asked to release it is typically required to file the release of information.
How to fill out release of information?
To fill out a release of information form, you must provide your personal information, specify the information you wish to release, and indicate the recipient of the information.
What is the purpose of release of information?
The purpose of release of information is to allow the sharing of specific information or documents with a designated party while ensuring the privacy and confidentiality of the information.
What information must be reported on release of information?
The information that must be reported on a release of information form typically includes the type of information being released, the purpose of the release, and the recipient of the information.
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