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Office Use Only Verified By: Acct #: Process Date: # of Pages: Processed By: AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION I hereby authorize the use or disclosure of my identifiable health
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Read the phrase "I understand that if" along with the statement or condition that follows it.
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i understand that if is a form required to be filed by certain individuals who receive income from sources such as wages, salaries, or other forms of compensation.
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