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PATIENT AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION PATIENT AUTHORIZATION FOR USE AND DISCLOSURE By signing this authorization, I authorize Community Care Entity below to

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By signing this authorization, you are giving permission for a specific action or access to be taken on your behalf.

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The individual or entity specified in the authorization form is required to file by signing this authorization.

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What is the purpose of by signing this authorization?

The purpose of signing this authorization is to grant permission for a specific action to be taken or access to be granted.

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