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County of San Bernardino Department of Behavioral Health AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION (PHI) Name of Client: Gender: Male / Date of Birth: Female / Social Security: XXXIX
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Visit the official website of the county of San Bernardino.
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The county of San Bernardino is a county located in the state of California.
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California DBH Bernardino CFR COM001 HIPAA xx authorizes invalidate restrict referral xxx criminally disclosed PHI Compliance disclosure EXPIRATION expires expressly cancellation Provider Behavioral Completion confidentiality spouse digits

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