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CahabaMedicalCare Phone:(205)9262992/Fax:(205)3167675AuthorizationtoDiscloseHealthInformation PatientName:___ DateofBirth:___ IauthorizeCahabaMedicalCaretouseordisclosetheabovenamedindividualshealthinformationasdescribedbelow. Thetypeandamountofinformationtobeusedordisclosedisasfollows:(includedateswhereappropriate) [] Problems,

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