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AUTHORIZATION FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION ST. ANDREWS HEALTH CENTER #13A 316 KHMER STREET POTTINESS, ND 58318 7012289300PATIENT: (Birth Date/Medical Record Number)(Name of Patient/Previous
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Andrews Health Center 13a is a form used for reporting health center services provided by Andrews Health Center.
Health centers and clinics that provide healthcare services are required to file Andrews Health Center 13a.
Andrews Health Center 13a can be filled out by providing details of the healthcare services provided, number of patients served, and other required information as specified in the form.
The purpose of Andrews Health Center 13a is to track and report healthcare services provided by health centers and clinics.
Information such as number of patients served, types of healthcare services provided, and other relevant details must be reported on Andrews Health Center 13a.
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