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Directory Results for 4/14 DR-1 Office of Appeals Form Massachusetts Department of Revenue Social Security or Federal Identification number Spouse s name (if taxpayer is married filing jointly) Spouse s Social Security number Mailing address City/Town State Name and to 4/14 Authorization for Use or Disclosure of Protected Health Ination Under federal law, no medical plan, hospital or physician may use or disclose certain protected health information (PHI) for uses other than treatment, payment or