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REQUEST FOR RELEASE OF BEHAVIORAL HEALTH RECORDS CMG Mental Health Wellness Center 2318 8th Street Lewiston, ID 83501 Tel: (208) 7461383 Fax: (833) 9413874Patient Name:Patient Date of Birth:Patient
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How to fill out request for release of

01
Obtain the necessary forms for requesting a release of information.
02
Fill out the requested information in the forms accurately and completely.
03
Provide any supporting documentation as required.
04
Submit the completed forms and documentation to the appropriate party as specified.

Who needs request for release of?

01
Individuals who require access to their own personal information held by an organization.
02
Legal representatives who are acting on behalf of an individual.
03
Government agencies or law enforcement officials with a valid reason for requesting the information.
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The request for release of is a formal application made to authorize the release of something, such as funds or property.
The request for release of is required to be filed by the individual or entity seeking the release of the funds or property.
To fill out a request for release of, one must provide the necessary information and supporting documentation as required by the governing authority.
The purpose of request for release of is to formally request the authorization for the release of funds or property.
The request for release of must include details such as the purpose of the release, the amount or value of the funds or property, and any relevant supporting documentation.
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