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Authorization for Disclosure of Protected Health Information I hereby authorize the Team Physicians from the ICU Health System and Certified Athletic Trainers representing William & Mary Campus Recreation

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What is wwwwmedu sportclubs wm-phi-form-authorization for?

The wwwwmedu sportclubs wm-phi-form-authorization is used to authorize the release of Protected Health Information (PHI) for sports clubs at wwwwmedu.

Who is required to file wwwwmedu sportclubs wm-phi-form-authorization for?

Any individual participating in the sports clubs at wwwwmedu is required to file the wm-phi-form-authorization.

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The form can be filled out by providing personal information, signing the authorization, and specifying the PHI that can be released.

What is the purpose of wwwwmedu sportclubs wm-phi-form-authorization for?

The purpose of the form is to allow wwwwmedu sports clubs to share relevant health information in case of emergencies.

What information must be reported on wwwwmedu sportclubs wm-phi-form-authorization for?

The form requires basic personal information, details of the PHI to be released, and the duration for which the authorization is valid.

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