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LLCAuthorizationforReleaseofMedicalInformationInitiatedbyPatient Patient name: DateofBirth: / / IauthorizeColoradoCenterforArthritisandOsteoporosis(CCA)touseordisclosethefollowingprotectedhealthinformation:FROM:TO:
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Cocodoccomform485056732 is a form used to authorize the request and receipt of specific information or documents.
Individuals or entities seeking to obtain or authorize access to specific information or documents are required to file this form.
To fill out the form, provide accurate personal information, specify the information being requested, and sign the authorization.
The purpose of this form is to facilitate the lawful request and reception of information or documents by authorized parties.
The form must report the requestor's details, the nature of the documents requested, the authority under which the request is made, and consent signatures.
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