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Authorization For Release Of Protected Health Information I, date of birth / /, hereby request and authorize The Florida Hospital Physician Group, Inc. Practice Name: Practice Location/Address: q
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Who needs fhpgauthorizationtoreleasephi12172013 20140321t195344z-1doc?
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Individuals who are required to release protected health information (PHI) as governed by the fhpgauthorizationtoreleasephi12172013 20140321t195344z-1doc form.
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Healthcare providers or institutions who need to obtain consent from patients or individuals before disclosing their PHI.
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