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SHCSStaff:___ Page1of2PATIENTNAME___ Student ID#___UniversityofCalifornia, Davis StudentHealthandCounselingServices ReleaseofInformationDepartment OneShieldsAvenue, Davis,CA95616Phone(530)7526129Fax(530)7525587Birthdate:___Phone:___AUTHORIZATIONFORRELEASEOFHEALTH
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01
Obtain the Roi form for release from the respective department or institution.
02
Fill out all the required fields including personal information such as name, address, contact information, etc.
03
Provide information about the release of records or information that is being requested.
04
Sign and date the form to certify the accuracy of the information provided.
05
Submit the completed Roi form for release to the designated individual or department as per the instructions.

Who needs roi form for release?

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Individuals who are requesting access to their own records or information
02
Legal representatives or guardians requesting on behalf of someone else
03
Healthcare providers or institutions requesting patient information for treatment purposes
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Insurance companies or legal entities requiring records for claims processing or legal proceedings
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The Return on Investment (ROI) form for release is a document used to calculate the financial return on an investment made by an individual or organization.
Any individual or organization that has made an investment and wants to track the return on that investment is required to file the ROI form for release.
To fill out the ROI form for release, one must input the initial investment amount, any additional investments made, and the revenue or profit generated from the investment.
The purpose of the ROI form for release is to provide a clear understanding of the financial performance of an investment and to help make informed decisions about future investments.
The ROI form for release must include details such as the initial investment amount, additional investments, revenue generated, expenses incurred, and the calculated return on investment.
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