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AUTHORIZATION FOR RELEASE OF PATIENT RECORD INFORMATION FROM Storybook Dental Name of Patient: Address of Patient: Number & Street Apt. City State Zip Patient Date of Birth: / / I hereby authorize

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What is authorization for release of?

Authorization for release of allows an individual or entity to release confidential information to a specified recipient.

Who is required to file authorization for release of?

Any individual or entity who wants to release confidential information to a specified recipient is required to file authorization for release of.

How to fill out authorization for release of?

Authorization for release of can be filled out by providing the necessary personal information, specifying the recipient of the information, and signing the form.

What is the purpose of authorization for release of?

The purpose of authorization for release of is to ensure that confidential information is only released to authorized individuals or entities.

What information must be reported on authorization for release of?

Authorization for release of typically requires information such as the individual's name, date of birth, contact information, and the specified recipient of the information.

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