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Worksite BenefitsClaims Department P.O. Box 925309 Houston, Texas 770925309Authorization to Obtain and Disclose Protected Health Information and Other Information Name: Policy No: I authorize the
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What is disclm-1213 final 312?
disclm-1213 final 312 is a form used for disclosure of financial information.
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Individuals or entities with specific financial responsibilities are required to file disclm-1213 final 312.
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