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MIMOSAS AUTHORIZATION FOR USE/DISCLOSURE OF PROTECTED HEALTH INFORMATIONFacility Name Western State Hospital, P.O. Box 2500, Staunton, VA 244022500Telephone Number (540) 332 Fax Number (540) 332 Patient
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DMHMRSAS authorization for usedisclosure is a form that allows the disclosure of information related to mental health, developmental disabilities, and substance abuse services in Virginia.
Healthcare providers, facilities, and organizations that handle mental health, developmental disabilities, and substance abuse services are required to file DMHMRSAS authorization for usedisclosure.
DMHMRSAS authorization for usedisclosure can be filled out by providing the necessary information about the individual, the authorized recipient, and the purpose of the disclosure.
The purpose of DMHMRSAS authorization for usedisclosure is to ensure that confidential information related to mental health, developmental disabilities, and substance abuse services is only disclosed to authorized individuals or entities.
The information that must be reported on DMHMRSAS authorization for usedisclosure includes the name of the individual, the type of information being disclosed, the authorized recipient, and the purpose of the disclosure.
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