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CONSENT FOR USE AND DISCLOSURE OF HEALTH INFORMATION SECTION A: PATIENT GIVING CONSENT Name:___ Email:___ Address:___ Telephone:___ Social Security #:___ SECTION B: TO THE PATIENTPLEASE READ THE FOLLOWING
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Section B of a form typically refers to a specific part or section of a document where certain information needs to be provided.
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Section B must be filled out according to the instructions provided on the form, typically by entering the required information in the designated fields.
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The specific information that must be reported on Section B will vary depending on the form, but it typically includes details such as names, dates, amounts, etc.
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