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LAKE REGIONAL IMAGING PARTNERS, LLC OSAGE BEACH, MO 65065 Fax: (573) 348-8223 (HIM) AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION Phone: (573) 348-8729 (HIM) Other Fax: Raw.
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1423-img-ctr-auth-disclosureof is a form used for disclosing authorization and disclosure information.
Individuals or entities authorized to make certain disclosures are required to file 1423-img-ctr-auth-disclosureof.
Fill out the form by providing the required authorization and disclosure information as specified on the form.
The purpose of 1423-img-ctr-auth-disclosureof is to ensure transparency and proper authorization of disclosures.
Information such as the nature of disclosures, authorization details, and relevant contact information must be reported on 1423-img-ctr-auth-disclosureof.
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