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Authorization to Disclose
Protected Health Information
Use this form to authorize Tufts Health Plan* to use or disclose your protected health information.
All fields are required. Incomplete or incorrect
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All fields required refers to the mandatory sections that must be completed on a specific form or document.
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What information must be reported on all fields are required?
The information that must be reported includes specific data points as outlined in the instructions for the form, such as identification details, financial information, and relevant disclosures.
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