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AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION Developed for Texas Health & Safety Code 181.154(d) effective June 2013Please read this entire form before signing and complete all the sections
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01
Obtain the necessary forms from the appropriate healthcare regulatory agency.
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Fill out all required information accurately, including the name of the healthcare provider and any authorized representatives.
03
Include all relevant contact information, such as the address, phone number, and email of the healthcare provider.
04
Provide information about the services offered by the healthcare provider, as well as any specialties or areas of expertise.
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Submit the completed form according to the instructions provided by the regulatory agency.

Who needs hoph healthcare pllc dba?

01
Healthcare providers who are operating under a different name or as a separate entity may need to fill out hoph healthcare pllc dba to register their business accurately.
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This form is essential for establishing the legal identity of the healthcare provider and ensuring compliance with regulatory requirements.
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Hoph Healthcare PLLC DBA refers to a healthcare professional limited liability company that operates under a 'doing business as' name, which means it provides healthcare services under a name different from its registered legal name.
Individuals or entities that operate a healthcare business under a name different from their registered legal name must file for Hoph Healthcare PLLC DBA.
To fill out Hoph Healthcare PLLC DBA, one must typically complete a registration form with the appropriate state or local agency, providing necessary details about the business name, owner information, and the nature of services offered.
The purpose of Hoph Healthcare PLLC DBA is to legally register the business name under which healthcare services will be provided, ensuring compliance with local laws and aiding in brand recognition.
The information that must be reported typically includes the business name, owner’s name, address, contact information, and the nature of the healthcare services provided.
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