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LINCOLN ORGAN, P. C
Authorization to Release Protected Health Information
This is an authorization under the Privacy Rules of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA).
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04
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07
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08
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09
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01
Anyone who requires authorization for a specific purpose needs to sign this authorization form.
02
This can include individuals, businesses, or organizations that need to grant permission or access to certain information, actions, or resources.
03
The specific entities or individuals who need the authorization can vary depending on the context and purpose of the form.
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