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Authorization to Disclose Health Care Information Seattle University Student Health Center 1111 E. Columbia Street #107 Seattle, WA 98122 Phone: 206.296.6300 Fax: 206.296.6089Patient Name:___ Former

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Download the consent-to-release-201911doc form from the provided link.

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Fill out all required fields including your name, contact information, and the information of the party you are authorizing to release information to.

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Submit the form to the appropriate party or organization as specified.

Who needs consent-to-release-201911doc - authorization to?

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Individuals who want to authorize a third party to release their personal information to another party or organization.

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What is consent-to-release-201911doc - authorization to?

It is a form that grants permission to release certain information.

Who is required to file consent-to-release-201911doc - authorization to?

Individuals who want to authorize the release of their information.

How to fill out consent-to-release-201911doc - authorization to?

The form must be completed with the required information and signed by the individual authorizing the release.

What is the purpose of consent-to-release-201911doc - authorization to?

The purpose is to ensure that information is only released with the consent of the individual.

What information must be reported on consent-to-release-201911doc - authorization to?

Personal information such as name, contact details, and the specific information being authorized for release.

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