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AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION (From St. Thomas More to Another Entity) Patient Name: Social Security #: Address: Birthdate: Telephone: Medical Record#: Medical Information
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The 'from st thomas more' is a form used for reporting financial information related to the St. Thomas More organization.
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The purpose of the 'from st thomas more' form is to gather and report financial information to ensure transparency and compliance within the St. Thomas More organization.
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The 'from st thomas more' form requires reporting of income, expenses, assets, liabilities, and other financial data related to the St. Thomas More organization.
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