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Authorization for Release of Protected Health Information (PHI) Patient Name Date of Birth / Address Telephone / Cell / / I hereby authorize (name of facility/provider releasing information) to disclose
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Phi - wellness brain is a tool used to ccollect information about an individual's overall wellness and brain health.
Anyone who wants to track and improve their overall wellness and brain health is encouraged to fill out phi - wellness brain.
Phi - wellness brain can be filled out online through a secure platform by answering questions about your daily habits and health markers.
The purpose of phi - wellness brain is to provide individuals with insights into their overall wellness and brain health, and to help them make informed decisions about their health.
Information such as daily habits, exercise routine, sleep quality, stress levels, cognitive function, and overall well-being must be reported on phi - wellness brain.
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