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AUTHORIZATION TO USE & DISCLOSE PROTECTED HEALTH INFORMATION FOR OFFICE USE ONLY PART 1: CLIENT/PATIENT INFORMATIONClient/Patient Last Name Client/Patient First Name Middle Initializer Names Used
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Anyone who needs to authorize the use of Multimulticare services or resources can use the form www.uslegalforms.comform-library537905-multimulticare authorization to use. This can include individuals, organizations, or businesses who require access to Multimulticare services for various purposes, such as medical treatment, research, or other authorized activities.

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The form is used to authorize the use of specific information by a healthcare provider for the purpose of providing medical care.
The patient or legal guardian is required to fill out and file the authorization form.
The form must be completed with the patient's personal information, the information of the healthcare provider, and specific details regarding the authorization being granted.
The purpose is to allow a healthcare provider to access and use the patient's medical information for the purpose of providing medical care.
The form must include the patient's full name, date of birth, contact information, medical history, and the specific information being authorized for use.
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