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Authorization for Release of Medical Information to Hollis ton Pediatric Group Release Information to:Hollis ton Pediatric Group Hollis ton Office: p. 508.429.2800; f. 508.429.7913 100 Jeffrey Avenue,
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01
Obtain the authorization for release of form from the organization requesting it.
02
Fill out the personal information section including your name, date of birth, and contact information.
03
Specify the information you are authorizing to be released and to whom it should be released to.
04
Sign and date the form in the designated areas.
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Make a copy of the completed form for your records before submitting it.

Who needs authorization for release of?

01
Anyone who wants to authorize the release of their personal information to a specific individual or organization.
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Authorization for release of is a document that allows the release of confidential information to a specified individual or organization.
Any individual or organization that needs to release confidential information to a third party is required to file authorization for release of.
Authorization for release of can be filled out by providing the necessary information about the parties involved, the information to be released, and any restrictions or limitations.
The purpose of authorization for release of is to ensure that confidential information is only released to authorized parties and in compliance with privacy regulations.
Authorization for release of must include details about the parties involved, the specific information to be released, the purpose of the release, and any restrictions or limitations.
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