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AUTHORIZATION FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION WORKFORCE HEALTH PATIENT NAME: PREVIOUS NAMES, IF APPLICABLE: ADDRESS: DATE/TIME OF REQUEST: DATE OF BIRTH: PHONE: () — PEOPLES OFT ID:
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How to fill out previous names if applicable

How to Fill Out Previous Names if Applicable:
01
Start by locating the section in the form that asks for previous names, typically found under the personal information or identification section.
02
If you have never changed your name before, you can simply leave this section blank. It is only necessary to provide previous names if you have legally changed your name in the past.
03
If you have changed your name, list your previous name(s) in the space provided. This could include your maiden name, a previous married name, or any other name by which you were previously known.
04
Be sure to provide the full and accurate spelling of your previous name(s) to avoid any confusion or discrepancies in your application.
05
If you have changed your name multiple times, you may need to provide additional documentation or provide a separate section to list all previous names.
06
It is important to be truthful and accurate when filling out this section. Providing false information or omitting previous names could result in legal issues or complications with your application.
Who Needs Previous Names if Applicable?
01
Individuals who have legally changed their names in the past are typically required to provide their previous names on various forms or applications.
02
This could include individuals who have changed their name due to marriage, divorce, adoption, or any other legal process.
03
Providing previous names allows for proper identification and verification of an individual's personal history.
04
It is particularly important in cases where official records or documents need to be matched or cross-referenced.
05
Government agencies, financial institutions, educational institutions, and legal entities often require individuals to provide their previous names when applying for various purposes.
06
Additionally, disclosing previous names helps ensure that an individual's identification and background information can be accurately tracked, especially for matters relating to security, legal compliance, or historical records.
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What is previous names if applicable?
Previous names refer to any names that an individual or business entity has used in the past.
Who is required to file previous names if applicable?
Individuals or business entities who have changed their name in the past are required to file their previous names.
How to fill out previous names if applicable?
To fill out previous names, you would need to provide a list of all the names that you or your business entity have used in the past.
What is the purpose of previous names if applicable?
The purpose of reporting previous names is to provide a complete record of all names associated with an individual or business entity.
What information must be reported on previous names if applicable?
The information that must be reported on previous names includes the full name(s) used in the past and the time period during which each name was used.
How can I send previous names if applicable for eSignature?
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