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Rev. February 2022AUTHORIZATION TO USE OR DISCLOSE PROTECTED HEALTH INFORMATION (PHI) Patient Name: Address:LastFirstStreet AddressPhone:Date of Birth:Middle CityStateZip Code_Social Security Number: I

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How to fill out i hereby authorize oklahoma

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Obtain the 'I Hereby Authorize Oklahoma' form.

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Individuals who need to grant authorization for specific actions or permissions in the state of Oklahoma.

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