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The 4550 West 109 Street Suite 130 Overland Park, KS 66211 9135419495 Authorization for the use and×or disclosure of protected health information Patient Name: Date of Birth: Address: Phone number:
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Who needs authorization for form use?
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Individuals who are required to access or use certain forms for specific purposes may need authorization. This can include employees, contractors, applicants, or individuals applying for specific services or benefits.
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The specific requirements for authorization may vary depending on the form and the purpose for which it is used. It is important to review the instructions or guidelines provided with the form to determine who needs authorization.
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