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University of North Carolina at Chapel Hill, Campus Health Services CB # 7470, Chapel Hill, NC 275997470 (919) 9662283, Fax (919) 9660616 ATTENTION: Health Information Management AUTHORIZATION FORM
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What is chsauthorizationform2012doc?
chsauthorizationform2012doc is a document used to authorize the release of medical information.
Who is required to file chsauthorizationform2012doc?
Any individual or entity seeking to obtain medical information from a healthcare provider must file chsauthorizationform2012doc.
How to fill out chsauthorizationform2012doc?
To fill out chsauthorizationform2012doc, provide your personal information, specify the purpose of the medical information release, and sign the form.
What is the purpose of chsauthorizationform2012doc?
The purpose of chsauthorizationform2012doc is to obtain authorization from a patient or their legal representative to release their medical information.
What information must be reported on chsauthorizationform2012doc?
chsauthorizationform2012doc requires the reporting of the patient's name, contact information, specific medical information to be released, and the purpose or recipient of the information.
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