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AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION Use this form to authorize USF HP * to use or disclose your protected health information. All fields are required. Incomplete or incorrect forms
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This is the domain for authorization purposes.
Individuals or entities who need authorization.
Fill out the required information accurately and completely.
The purpose is to obtain authorization for certain actions or access.
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Penalties may vary depending on the authorization requirements and circumstances.
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