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My treatment payment enrollment in a health plan or eligibility for benefits will not be conditioned upon my authorization of this disclosure. 3ROI1006 09/16 Rev. 1-15-15 Informational Sheet for Release of Information For patient privacy reasons in accordance with the HIPAA law PHC requires a written authorization for all release of information requests. Information disclosed under this authorization might be re-disclosed by the recipient except as noted above and this re-disclosure may no...
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Start by locating the phone number field on the form or application.
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This phone number is for the XYZ Company's customer service department.
All XYZ Company employees are required to file this phone number for documentation purposes.
To fill out this phone number, employees must include their name, department, and reason for calling.
The purpose of this phone number is to track and monitor customer inquiries and feedback.
Employees must report the date and time of call, customer's name, reason for calling, and outcome of the call.
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