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4424 S. 86th Street Lincoln, NE 68526 402-483-8500 Fax 402-483-8501 CONSENT TO RELEASE INFORMATION Patient Name: Other Names Used: Address: Date of Birth: Phone Number: I hereby authorize Health information

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1. Start by obtaining the necessary form or document for s l f m.
2. Read and understand the instructions provided on the form. Make sure to follow any specific guidelines or requirements.
3. Begin by filling out the personal information section, which may include your name, address, contact information, and any other relevant details.
4. Proceed to the "s" section and fill in any required information related to this category. This could refer to any specific details or data that is relevant to the form you are filling out.
5. Move on to the "l" section and provide the necessary details for this category. Again, this could vary depending on the form or document you are completing.
6. Continue to the "f" section and fill in any required information related to this category. This could pertain to any further information or specifics that the form requires.
7. Finally, complete the "m" section by providing any additional details or data that may be needed. This could include any relevant remarks, comments, or other pertinent information.
8. Review the entire form to ensure that all sections have been properly filled out and that there are no mistakes or omissions.
9. Sign and date the form as required, and attach any necessary supporting documents if requested.
10. Submit the completed form to the appropriate recipient or entity, following any further instructions or guidelines provided.

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1. Individuals or organizations who require specific information related to the subject matter covered by s l f m.
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3. Anyone involved in a situation or transaction that necessitates the completion of s l f m, as outlined by applicable laws, regulations, or protocols.

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