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AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INFORMATION*** All Sections Must Be Completed For Valid Release *** PATIENT INFORMATION Name: Date of Birth: Address: City: State: Zip Code: Phone: AUTHORIZATION
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To fill out all sections, you should follow these steps:
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All individuals who are required to complete a form with multiple sections must fill out all sections. This may include job applicants, students applying for scholarships or admissions, professionals completing registration forms, and individuals filling out government or legal forms.
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All sections must be refers to the required parts of a specific form or document that must be completed for compliance with regulations or laws.
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