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FORM 161AUTHORIZATION FOR USE OR DISCLOSURE OF HEALTH INFORMATION Completion of this document authorizes the disclosure and use of health information about you. Failure to provide all information
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Completion of this document refers to filling out all required fields and sections.
The party or individual designated by the governing body is required to file completion of this document.
Completion of this document can be filled out electronically or manually, following the instructions provided by the governing body.
The purpose of completion of this document is to ensure all necessary information is accurately reported.
Information such as personal details, financial data, and any relevant documents must be reported on completion of this document.
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