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SEND COMPLETED FORM TO: Fax: (860) 4070359 or Email: aimhigher@priahealthcare.comHIPAA COMPLIANT AUTHORIZATION FOR THE RELEASE OF PATIENT INFORMATION AND APPOINTMENT OF AUTHORIZED REPRESENTATIVE (Privacy

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What is may a valid authorization?

A valid authorization is a legal document giving someone permission to act on behalf of another person or entity.

Who is required to file may a valid authorization?

Any individual or entity who needs to represent or make decisions on behalf of another party may be required to file a valid authorization.

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A valid authorization can be filled out by providing all necessary information about the authorized individual or entity, the scope of authority granted, and any specific instructions or limitations.

What is the purpose of may a valid authorization?

The purpose of a valid authorization is to establish a formal agreement allowing someone to act or make decisions on behalf of another party.

What information must be reported on may a valid authorization?

The information to be reported on a valid authorization may include the names of the parties involved, the scope of authority granted, any limitations or restrictions, and the effective date of the authorization.

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