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WHITTIER POLICE DEPARTMENT Report # REQUEST FOR RELEASE OF INFORMATION Name of Applicant: Agency: (Please Print) Home Address: Home telephone: Work Address: Work/Cell telephone: REQUESTED INFORMATION:
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What is release of information new?
Release of information new is a form used to authorize the disclosure of protected health information.
Who is required to file release of information new?
Any individual or entity seeking to access or release protected health information is required to file a release of information form.
How to fill out release of information new?
To fill out a release of information form, one must provide their personal information, specify the type of information being released, and indicate to whom the information should be disclosed.
What is the purpose of release of information new?
The purpose of release of information new is to ensure the privacy and confidentiality of protected health information while allowing for its appropriate disclosure under certain circumstances.
What information must be reported on release of information new?
The release of information new form typically requires the individual's full name, date of birth, the specific information to be disclosed, the purpose of the disclosure, and the signature of the individual authorizing the release of information.
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