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AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION 1. Clients name: First Name Middle Name Last Name 2. Date of Birth: / / 3. Date authorization initiated: / / 4. Authorization initiated
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How to fill out client s name

How to fill out client's name:
01
Begin by entering the first and last name of the client in the designated field on the form.
02
Ensure that the spelling of the client's name is accurate and matches their official identification documents.
03
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If the client has a preferred name or nickname, consider including it in parentheses after their legal name.
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If the client has a middle name, include it in the appropriate field.
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If the client has any special instructions or preferences regarding their name, make sure to follow them.
Who needs client's name:
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Overall, anyone who deals with the client's information or provides them with products or services needs their name for identification, record-keeping, and communication purposes.
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