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Directory Results for AUTHORIZATON FOR RELEASE OF INATION I authorize Green Hills Pediatric Associate (GHPA) to use and/or disclose my childs/childrens protected health information (PHI) to: The information to be included for use and/or disclosure: (Check to AUTHORIZATON FOR THE USE OR DISCLOSURE OF PROTECTED HEALTH INATION

AUTHORIZATON FOR RELEASE OF INATION I authorize Green Hills Pediatric Associate (GHPA) to use and/or disclose my childs/childrens protected health information (PHI) to: The information to be included for use and/or disclosure: (Check
Authorizaton for Release of Medical Ination - HIPAA
Authorizaton for the use or disclosure of protected health ...
AUTHORIZATON FOR THE USE OR DISCLOSURE OF PROTECTED HEALTH INATION