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JOHNIICONIYHealth & Environment 11875 S. Sunset Drive, Suite 300, Olathe, KS 66061Release of Information Authorization ___ Phone NumberPatient Name AddressCityDate of Birth Statewide authorize the

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What is release of information authorization?

Release of information authorization is a legal document that allows the disclosure of an individual's protected health information to a specified person or entity.

Who is required to file release of information authorization?

Individuals or their legal representatives are typically required to file release of information authorization.

How to fill out release of information authorization?

To fill out release of information authorization, one must provide their personal information, specify the recipient of the information, and sign the form.

What is the purpose of release of information authorization?

The purpose of release of information authorization is to ensure that an individual's protected health information is disclosed only to authorized individuals or entities.

What information must be reported on release of information authorization?

On release of information authorization, one must report their personal information, the recipient of the information, the purpose of the disclosure, and the date range of the authorization.

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