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HEALTH INFORMATION SERVICES PHONE:713-439-6136 FAX: 713-439-1134 AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION Patient s Name Last First Maiden Birthdate Address Street City State Zip
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The English - Harris County form is a document that must be filed by certain individuals residing in Harris County, Texas.
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To fill out the English - Harris County form, individuals must provide specific information and follow the instructions provided by the local government in Harris County, Texas.
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The English - Harris County form may require individuals to report their personal information, residency status, and other details as requested by the local government in Harris County, Texas.
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