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Authorization for Disclosure of Healthcare Information Client Name: Birth date: / / SS#: Previous Name(s): Address: Freedman & Associates Treating Provider: Information is to be disclosed to and/or
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How to fill out child amp family forms:

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Begin by carefully reading all instructions and guidelines provided with the forms. Make sure you understand the purpose and requirements of each section.
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Fill in your personal information accurately, including your name, address, contact details, and any other required details. Double-check for any spelling errors or missing information.
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Sign and date the forms where required. If there are additional sections that require the signature of a spouse or other party, ensure they also sign and date appropriately.
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