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Authorization to Use and Disclose Health Information P.O. Box 25010 Little Rock, AR 72221Notice to Member: Completing this form will allow Arkansas Total Care to (i) use your Protected Health Information(PHI)

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Obtain the artc22-h-233 form from the appropriate organization or website.

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Individuals who require authorization for a specific purpose, such as medical treatment, travel, or access to restricted areas, may need to fill out artc22-h-233 - authorization form.

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Artc22-h-233 authorization is a form required for authorization to access certain restricted areas or information.

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Employees or individuals who need access to specific restricted areas or information are required to file artc22-h-233 authorization.

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To fill out artc22-h-233 authorization, individuals need to provide personal information, reason for access, and any necessary background checks or documentation.

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The purpose of artc22-h-233 authorization is to ensure that only authorized individuals have access to restricted areas or confidential information.

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Information such as name, contact information, reason for access, and any relevant background information may need to be reported on artc22-h-233 authorization.

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