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Directory Results for May be used as a tool by you or your DVR counselor to help determine the details of your IPE to MAY BE USED AS AN ORIGINAL AUTHORIZATION FOR RELEASE OF HEALTH INATION PURSUANT TO HIPAA Patient Name: Date of Birth: Social Security Number: Patient Address: I, or my authorized representative, request that health information regarding

May be used as a tool by you or your DVR counselor to help determine the details of your IPE
MAY BE USED AS AN ORIGINAL AUTHORIZATION FOR RELEASE OF HEALTH INATION PURSUANT TO HIPAA Patient Name: Date of Birth: Social Security Number: Patient Address: I, or my authorized representative, request that health information regarding