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AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION Patient Name: __ _ ______ _ ___ _ __ SSN:____( Date of Birth:___ _ ___ _ Telephone#: _I, ___ , hereby authorize the release of my medical information

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How to fill out date of birth telephone

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Start by accessing the form or application that requires you to fill out your date of birth and telephone number.

02

Locate the fields designated for date of birth and telephone number.

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Enter your date of birth in the specified format (e.g. MM/DD/YYYY).

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Enter your telephone number including the area code.

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Double-check your entries to ensure accuracy before submitting the form.

Who needs date of birth telephone?

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Organizations that require personal information for identification purposes such as government agencies, financial institutions, healthcare providers, and employers may need your date of birth and telephone number.

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