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OPHTHALMIC ASSOCIATES OF BILLINGS, L.L.C. 4033 Avenue B BILLINGS, MT 59106 (406)2566000CONSENT TO USE OR DISCLOSE HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONSPatient name ___
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The form-concenttodisclose-20240430docx is a document used to provide consent for disclosing specific information.
Individuals or organizations who need to disclose specific information are required to file the form-concenttodisclose-20240430docx.
The form-concenttodisclose-20240430docx is typically filled out by providing the necessary information requested on the form and signing to give consent for disclosure.
The purpose of form-concenttodisclose-20240430docx is to legally authorize the disclosure of specific information to designated individuals or organizations.
The form-concenttodisclose-20240430docx requires the specific information that needs to be disclosed, the parties involved, and any conditions or limitations on the disclosure.
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