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Laden Akhtar, M. D. Thu ha Ham, M.D. Amiga Saharan, MSN, APRN, FNPC240 Adriatic Parkway McKinney, Texas 75070 Phone: (972) 3829292Authorization for Use and Disclosure of Protected Health Record Information
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Typically, the form requires details about the requester, the resource/service being requested, and the intended use.
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