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Get the free www.nmhs.net app filesAUTHORIZATION FOR USE AND DISCLOSURE OF HEALTH ... - nmhs.net

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AUTHORIZATION FOR USE AND DISCLOSURE OF HEALTH INFORMATION Patient Name (Print): ___ Date of Birth: ___ Social Security Number (last 4 digits): X × × × X ___Primary Contact Number: ___Patient\'s
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It is used to authorize access to certain files or apps on the wwwnmhsnet platform.
Users who need access to specific files or apps on the wwwnmhsnet platform are required to file the authorization form.
The form can be filled out online or submitted in person by providing necessary information such as name, user ID, and the files or apps requiring authorization.
The purpose is to ensure restricted access to sensitive files or apps on the wwwnmhsnet platform.
Users must report their name, user ID, the specific files or apps needing access, and the reason for authorization.
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