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Maggie Alexander, PMH NP,LLCPsychiatricMentalHealthNursePractitioner1675SWMarlowSuite315,Portland,OR97225Telephone:5035239629.CONSENTFORRELEASEOFCONFIDENTIALINFORMATIONTOTHEPRIMARYCAREPROVIDERI, hereby
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Start by locating the form 'Hereby Authorize Maggie Alexander PMHNP to Receive Information from and/or'
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Make sure you have all the necessary information handy, such as name, contact details, and any relevant authorization details
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Begin filling out the form by providing your personal information, such as your name, address, and phone number
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What is herebyauthorizemaggiealexanderpmhnptoreceiveinformationfromandor?
Hereby authorize Maggie Alexander, PMHNP, to receive and utilize information from designated healthcare providers or institutions for the purpose of care coordination and treatment.
Who is required to file herebyauthorizemaggiealexanderpmhnptoreceiveinformationfromandor?
The individual seeking treatment or their legal guardian is required to file this authorization form.
How to fill out herebyauthorizemaggiealexanderpmhnptoreceiveinformationfromandor?
To fill out the form, provide necessary personal information, specify the information to be shared, and sign and date the document.
What is the purpose of herebyauthorizemaggiealexanderpmhnptoreceiveinformationfromandor?
The purpose of this authorization is to allow Maggie Alexander to collect and use necessary medical information to provide effective mental health care.
What information must be reported on herebyauthorizemaggiealexanderpmhnptoreceiveinformationfromandor?
The form must report the individual's personal identification, specific types of health information authorized for release, and the names of the healthcare providers involved.
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