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AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION (Page 1 of 2) 1. Client s name: First Name 2. Date authorization initiated: / / 4. Authorization initiated by: 5. Last Name Date
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Start by finding the date section on the form you are filling out. This is usually located near the top of the form and may be labeled as "Date Authorization Initiated" or something similar.
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Individuals applying for certain services or benefits may need to provide a date authorization initiated. This could include applications for loans, insurance, permits, or other official documents.
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Note: The specific requirements for date authorization initiated may vary depending on the context and the form or document being filled out. It is essential to carefully read and follow the instructions provided on the form or consult the relevant authority if you have any doubts or questions.
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