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*D0652A* Client×Patient ID Label CONSENT FOR RELEASE OF CONFIDENTIAL INFORMATION TO COURT PERSONNEL DRUG TREATMENT COURT PROGRAM Client×Patient Name: Health Record #: (last name, first name) Unit×Clinic×Service:
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The i hereby authorize form is a document that grants permission for a specific action or request.
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Individuals or entities who need authorization for a particular activity may be required to file the i hereby authorize form.
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To fill out the i hereby authorize form, you should provide your personal information, a description of the authorization request, and any supporting documentation.
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The purpose of the i hereby authorize form is to legally grant permission for a specific action or request to be carried out.
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The i hereby authorize form typically requires information such as the requester's name, contact details, the reason for the authorization request, and any relevant dates or deadlines.
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