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Genl-83 (Rev. 05/12) NEW YORK STATE POLICE 1220 Washington Avenue, Building 22 Albany, New York 12226-2252 AUTHORIZATION FOR RELEASE OF INFORMATION APPLICANT TO: The U.S. Armed Forces, Maritime Service,
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What is release of information form?
A release of information form is a legal document that authorizes the disclosure of protected health information to designated individuals or organizations.
Who is required to file release of information form?
The person or entity seeking to access or share someone's protected health information is required to file a release of information form.
How to fill out release of information form?
To fill out a release of information form, you need to provide the required personal information, specify the scope and purpose of disclosure, and sign the form to give your consent.
What is the purpose of release of information form?
The purpose of a release of information form is to ensure that individuals have control over the disclosure and sharing of their protected health information.
What information must be reported on release of information form?
The release of information form typically requires the reporting of personal details, such as name, date of birth, contact information, and specific details about the information to be disclosed.
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