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Directory Results for Authorization for Release of Protected Health Ination I hereby authorize Aetna Life Insurance Company and any of its parents, subsidiaries, and affiliates (including, but not limited to Aetna Health Management, Inc to AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INATION I, (print name) authorize the following health care provider and/or organization to disclose the following protected health information to the designated person and/or organization -

Authorization for Release of Protected Health Ination I hereby authorize Aetna Life Insurance Company and any of its parents, subsidiaries, and affiliates (including, but not limited to Aetna Health Management, Inc
Authorization for Release of Protected Health Ination I hereby authorize to release information of Facility/Person Patient Name Date of Birth as described below to: Facility/Person , , Address Phone Fax Records are requested for the
AUTHORIZATION FOR RELEASE OF PROTECTED HEALTH INATION I, (print name) authorize the following health care provider and/or organization to disclose the following protected health information to the designated person and/or organization -