Fillable Please release health care information to

Description
Authorization to Disclose Health Care Information Client name: Date of birth: Please release health care information to: Name and Organization: Address: City, State: Zip Code: Phone: By signing this Authorization, I authorize Counseling for Life, Inc. to disclose the following health information: All Health Information about me, including my clinical records, created or received by Counseling for Life, Inc. This...
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