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AUTHORIZATION TO USE AND DISCLOSE HEALTH INFORMATION(OTHER FACILITY TO RELEASE TO NORTON SOUND HEALTH CORPORATION) PatientPatient Name: (Patient) Birth Date: pH. #: Medical Record #: Address From
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Oformr facility to release is a form used to request the release of a facility.
Any individual or organization that needs to release a facility is required to file oformr facility to release.
Oformr facility to release can be filled out by providing relevant information about the facility and the reason for requesting its release.
The purpose of oformr facility to release is to formally request the release of a facility.
Information such as the facility's location, purpose, ownership, and the reason for release must be reported on oformr facility to release.
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