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AUTHORIZATION FOR RELEASE OF CONFIDENTIAL INFORMATION I hereby authorize (Name of hospital, Individual, or Agency) to release medical, psychiatric, drug, and or alcohol abuse or HIV testing, Aids
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What is name of hospital individual?
Individual name of the hospital.
Who is required to file name of hospital individual?
Hospital administrators or officials responsible for reporting.
How to fill out name of hospital individual?
Enter the individual's name in the designated field.
What is the purpose of name of hospital individual?
To identify the specific hospital staff member or personnel.
What information must be reported on name of hospital individual?
Full name of the individual working in the hospital.
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