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AUTHORIZATION FOR RELEASE OF HEALTH INFORMATIONBy signing this Authorization, I authorize Erie Retinal Surgery, Inc. (Medical Group) to use or disclose the healthinformation described below pertaining
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What is MODEL AUTHORIZATION FOR RELEASE OF HEALTH ... Form?

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Model authorization for release is a standardized document that grants permission for the release of certain information, typically related to financial or legal matters.
Individuals or entities that are required to disclose sensitive information, such as healthcare providers or financial institutions, are typically required to file a model authorization for release.
To fill out a model authorization for release, provide accurate personal information, specify the information being released, identify the recipient, and sign the document.
The purpose of model authorization for release is to ensure that individuals give informed consent for their information to be shared and to protect their privacy.
Information that must be reported includes the individual's name, the type of information being shared, the purpose of the release, and the duration of consent.
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