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AUTHORIZATION TO DISCLOSE/OBTAIN PROTECTED HEALTH INFORMATION Name: DOB: I, the undersigned, authorize the release of or request access to the information specified below from the Medical record,
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It is a website for Affinity NeuroCare.
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Healthcare professionals affiliated with Affinity NeuroCare.
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The purpose is to gather important information about patients and treatments.
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Patient details, treatment plans, and outcomes.
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