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P.O. Box 902
700 Lawn Avenue
Belleville, PA 18960
(215) 4534850AUTHORIZATION: RELEASE/DISCLOSURE OF HEALTH INFORMATION
(Page 1 OF 2)By signing this Authorization, you are permitting the use and/or
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What is authorization releasedisclosure of health?
Authorization releasedisclosure of health is a legal document that allows a healthcare provider to disclose an individual's health information to a designated third party.
Who is required to file authorization releasedisclosure of health?
The individual whose health information is being disclosed is required to file the authorization releasedisclosure of health form.
How to fill out authorization releasedisclosure of health?
Authorization releasedisclosure of health forms can typically be filled out by providing personal information, specifying the information to be disclosed, and naming the recipient of the information.
What is the purpose of authorization releasedisclosure of health?
The purpose of authorization releasedisclosure of health is to protect the privacy of individuals' health information and ensure that their information is only shared with authorized individuals or organizations.
What information must be reported on authorization releasedisclosure of health?
The information that must be reported on authorization releasedisclosure of health typically includes the individual's name, date of birth, the specific information to be disclosed, the purpose of the disclosure, and the name of the recipient.
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