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College Park Family Care Center 11755 W. 112th Street Overland Park, KS 66210 AUTHORIZATION FOR RELEASE OF HEALTH INFORMATION TO CPF CC Phone Number: Patient Name: Date of Birth: Address: I authorize

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What is cpfcc-auth to cpfcc-0811doc?

cpfcc-auth is the authorization form required to be filed by individuals or entities to authorize certain actions or transactions related to cpfcc-0811doc.

Who is required to file cpfcc-auth to cpfcc-0811doc?

Individuals or entities who need to authorize specific actions or transactions related to cpfcc-0811doc are required to file cpfcc-auth.

How to fill out cpfcc-auth to cpfcc-0811doc?

To fill out cpfcc-auth to cpfcc-0811doc, one must provide all necessary information accurately and sign the form to authorize the specified actions or transactions.

What is the purpose of cpfcc-auth to cpfcc-0811doc?

The purpose of cpfcc-auth to cpfcc-0811doc is to authorize specific actions or transactions related to cpfcc-0811doc by providing official authorization.

What information must be reported on cpfcc-auth to cpfcc-0811doc?

The information required to be reported on cpfcc-auth to cpfcc-0811doc includes personal or entity details, details of the actions or transactions to be authorized, and the signature of the authorized individual.

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