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Directory Results for : 960 AUTHORIZATION FOR RELEASE OF HEALTH INATION PURSUANT TO HIPAA This form has been approved by the New York State Department of Health Patient Name Date of Birth Social Security Number Patient Address I, or my authorized representative, reque to : 9601 PUBLISHERS K D &amp

: 960 AUTHORIZATION FOR RELEASE OF HEALTH INATION PURSUANT TO HIPAA This form has been approved by the New York State Department of Health Patient Name Date of Birth Social Security Number Patient Address I, or my authorized representative, reque
: 9601 PUBLISHERS K D &amp