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THE MENTAL HEALTH CENTER OF GREATER MANCHESTER Authorization for Release of InformationMedical Records The Mental Health Center of Greater Manchester 401 Cypress St. Manchester, NH 03103 Fax 6035185463
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Download the authorization-to-release-919pdf form from the appropriate website or request a physical copy.
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Read the instructions carefully to understand what information needs to be filled out.
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Fill in your personal information, such as name, address, date of birth, and contact details.
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Specify the information you are authorizing to be released and to whom it should be released to.
05
Sign and date the form to confirm your authorization.
06
Submit the completed form to the relevant party or organization as instructed.

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Individuals who need to authorize the release of their personal information to a specific party or organization.
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People who are applying for services or benefits that require authorization for the release of information.
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Patients who want to authorize healthcare providers to share their medical records with other healthcare professionals.
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The authorization-to-release-919pdf is a form that grants permission for the release of specific information.
Individuals or organizations seeking to authorize the release of information are required to file authorization-to-release-919pdf.
Authorization-to-release-919pdf can be filled out by providing required information such as name, contact details, specific information to be released, and signature.
The purpose of authorization-to-release-919pdf is to formalize and document the consent for the release of information.
Information such as the name of the individual or entity authorizing the release, the recipient of the information, the specific information to be released, and the purpose of the release must be reported on authorization-to-release-919pdf.
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