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Carolina Psychiatry Authorization For Use and Disclosure of Protected Health Information 45 C.F.R. Parts 160 and 164; 42 C.F.R. Part 2; G.S. 122C This authorization from implements the requirements
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Find the Carolina Psychiatry form online or get a physical copy from the Carolina Psychiatry office.
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Start by filling out your personal information, such as your name, date of birth, and contact information.
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Provide your medical history, including any previous psychiatric diagnoses, medications, and treatments.
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Answer all the questions in the form accurately and honestly.
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If you have any specific concerns or symptoms you want to discuss with a psychiatrist, make sure to mention them in the appropriate section of the form.
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Submit the filled-out form either by mail or by handing it over to the Carolina Psychiatry office personally.

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