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Print Form ST. FRANCIS HEALTHCARE SYSTEM OF HAWAII Reset Form AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION Patient's Name: Date of Birth: Telephone #: 1. By signing this Authorization form,
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Francis healthcare system is a network of hospitals, clinics, and other healthcare facilities.
All healthcare providers and organizations affiliated with Francis healthcare system are required to file.
You can fill out Francis healthcare system forms online or submit them through the mail.
The purpose of Francis healthcare system forms is to gather information on healthcare services provided and financial data.
Information such as patient demographics, services provided, revenue, and expenses must be reported.
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