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For ROI Office Use Only:Cont Care, Images:Date: ___ Date RCD: ___ Records Released: ___ Pt#: ___ ___ C LOC: ___AUTHORIZATION PARA LA DIVULGATION DE INFORMATION MICA POR favor, lea cuidadosamente antes

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pci-1400s-mpc-release-of-info-spanish-81216pdf is a form used to release information in Spanish.

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Individuals or entities who need to release information in Spanish are required to file pci-1400s-mpc-release-of-info-spanish-81216pdf.

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The purpose of pci-1400s-mpc-release-of-info-spanish-81216pdf is to authorize the release of information in Spanish.

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pci-1400s-mpc-release-of-info-spanish-81216pdf requires information such as the type of information being released, the purpose of the release, and the duration of the authorization.

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