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OTHER
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Directory Results for I,(Print Workers Name) , hereby authorize the health care provider (HCP) (the name of HCP is optional and not required for release of medical ination) (Print Health Care Provider's Name) the use or disclosure of my health information to I,(print your

I,(Print Workers Name) , hereby authorize the health care provider (HCP) (the name of HCP is optional and not required for release of medical ination) (Print Health Care Provider's Name) the use or disclosure of my health information
I,(print your