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AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION Patient Name: Date of Birth: I authorize the use or disclosure of the above named individuals health information as described below
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Bay Shore Pediatrics LLC is a medical practice specializing in pediatric care.
The owner or owners of Bay Shore Pediatrics LLC are required to file.
To fill out Bay Shore Pediatrics LLC, you will need to provide information about the business structure, ownership, financials, and other relevant details.
The purpose of Bay Shore Pediatrics LLC is to provide medical care and services to children and adolescents.
Information such as business address, ownership details, financial statements, and any relevant changes must be reported on Bay Shore Pediatrics LLC.
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