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Patient Authorization to Disclose, Release and/or Obtain Protected Health Information 1. Patient Information Name Last, First, Former Name(s)/Alias:Street AddressCityMedical Record Number (if known)StateBirthdateZip
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How to fill out former namesalias
How to fill out former namesalias
01
To fill out former names or aliases, follow these steps:
02
In the designated section of the form or document, write your current legal name as the primary name.
03
Below your current legal name, write any former names or aliases that you have used in the past.
04
If you have multiple former names or aliases, separate each name with a comma or a new line.
05
Include all variations of your former names or aliases, including different spellings or name orders.
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Make sure to provide accurate and complete information to avoid any confusion or discrepancies.
07
Sign and date the form or document once you have completed filling out the former names or aliases section.
Who needs former namesalias?
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Former names or aliases may be required or requested by various entities or organizations, including:
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- Government agencies (e.g., for background checks, identification purposes)
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- Legal or financial institutions (e.g., for documentation, verification purposes)
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- Educational institutions (e.g., for academic records, enrollment purposes)
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- Employers (e.g., for employment history, background checks)
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- Immigration or visa processes (e.g., for identity verification, documentation)
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- Personal or professional networks (e.g., for maintaining accurate contact information)
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It is important to provide former names or aliases when necessary to ensure transparency and accuracy in official records and interactions.
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What is former names/alias?
Former names/alias refer to any previous names or aliases that an individual may have used.
Who is required to file former names/alias?
Individuals who have legally changed their names or used aliases in the past are required to file former names/alias.
How to fill out former names/alias?
Former names/alias can be filled out by providing the previous names or aliases used by the individual.
What is the purpose of former names/alias?
The purpose of former names/alias is to ensure that all previous names or aliases used by an individual are properly documented.
What information must be reported on former names/alias?
The information that must be reported on former names/alias includes the previous names or aliases used by the individual.
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