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SURGERY AND ADMISSION NOTICE (FOR PHYSICIAN OFFICE USE ONLY)INSTRUCTIONS: 1.SURGICAL:CALL SURGERY SCHEDULING DEPARTMENT AT (562) 9331011 WITH APPLICABLE INFORMATION COMPLETED ON FORM BELOW. FAX COMPLETED

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What is authorization for release of?

Authorization for release of is a form that gives permission to release certain information or records to a specific individual or organization.

Who is required to file authorization for release of?

Any individual or organization that wants to obtain specific information or records from another party may be required to file an authorization for release of.

How to fill out authorization for release of?

To fill out authorization for release of, you will need to provide your personal information, specify the information or records you are requesting, and sign the form to give permission for the release of the information.

What is the purpose of authorization for release of?

The purpose of authorization for release of is to ensure that sensitive information or records are only shared with authorized individuals or organizations.

What information must be reported on authorization for release of?

The information that must be reported on authorization for release of includes the requester's personal information, the specific information or records being requested, and the purpose for the request.

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