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I understand that I may revoke this authorization at any time by notifying the HIM department in writing. 850 W. Irving Park Road Chicago IL 60613-3098 Ph 773-975-6813 Fax 773-525-7168 AUTHORIZATION TO DISCLOSE PRIVILEGED MEDICAL INFORMATION OR REVIEW OF MEDICAL RECORDS Patient Name Last Name Middle Initial First Name Date of Birth // Social Security Number Telephone Description of information that may be disclosed INPATIENT OUTPATIENT EMERGENCY ROOM CLINIC OUTPATIENT SURGERY OUTPATIENT...
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What is 850 w?
850 W refers to the form used to report certain gambling winnings to the IRS.
Who is required to file 850 w?
Any person or entity that receives gambling winnings over a certain threshold is required to file Form 850 W.
How to fill out 850 w?
Form 850 W must be filled out with accurate information about the gambling winnings received, including the amount, recipient's information, and payer's information.
What is the purpose of 850 w?
The purpose of Form 850 W is to report gambling winnings to the IRS for tax purposes.
What information must be reported on 850 w?
Form 850 W requires information such as the amount of gambling winnings, recipient's name, address, and taxpayer identification number, as well as the payer's information.
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