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LOCK HAVEN UNIVERSITY HEALTH SERVICES 401 N.FAIRVIEW ST. LOCK HAVEN, PA 17745 PHONE: (570) 484-2276 FAX: (570) 484-2522 RELEASE OF INFORMATION All portions of this form must be completed to constitute

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Record release-lock is a document used to authorize the release of confidential records or information.

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The information that must be reported on record release-lock includes the details of the record to be released, the reason for the release, and the authorization for the release.

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