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HIPAA PRIVACY AUTHORIZATION FORM ADVANCED DERMATOLOGY ASSOCIATES, LTD 1259 S. Cedar Crest Blvd, Suite 100 Allentown, PA 18103 6104374134 6104339690 (Fax) Ad Authorization for Disclosure of Protected

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Note: The specific purpose or context of the form 6104374134 is not mentioned in the question, so the answer provides possible general scenarios where such a form may be needed.

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What is 6104374134?

6104374134 is a specific form or document that needs to be filled out for a certain purpose.

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Certain individuals or entities may be required to file 6104374134 based on specific criteria.

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The purpose of 6104374134 is to gather specific information for a particular purpose or regulatory requirement.

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6104374134 may require reporting of certain financial or non-financial information as per the instructions on the form.