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215 South FM 548 Suite B Lorna, Texas 75126 9725642222 9725642322 Fax www.justforkidsforney.comRonald J. Garza, DDS, MS Joseph Parker, AUTHORIZATION TO RELEASE INFORMATION AND ASSIGNMENT OF DENTAL

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What is authorization to release information?

Authorization to release information is a legal document that allows an individual or entity to share specific information about a person with a third party.

Who is required to file authorization to release information?

Typically, the individual whose information is being released or their legal representative is required to file the authorization.

How to fill out authorization to release information?

To fill out the authorization, one must provide the individual's personal details, specify the information to be released, identify the recipient, and obtain the individual's signature acknowledging the release.

What is the purpose of authorization to release information?

The purpose is to protect the privacy of individuals by ensuring that personal information is only shared with consent, and to comply with legal and regulatory requirements.

What information must be reported on authorization to release information?

The reported information typically includes the individual's name, date of birth, the specific information to be released, and the parties involved.

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