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AUTHORIZATION TO RELEASE INFORMATION FORMS (100/CASE)


PROTECTED HEALTH INFORMATION MAY BE DISCLOSED WITHOUT WRITTEN AUTHORIZATION ONLY IN THE PURPOSES SPECIFICALLY OUTLINED IN THE NOTICE OF PRIVACY PRACTICE. ALL OTHER USES AND DISCLOSURES REQUIRE THIS FORM WHICH THE PATIENT FILLS OUT FOR AUTHORIZATION.
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 Other Items from HIPAA Forms (Style B)

  HIPAA STARTERS KIT - 
  NOTICE OF PRIVACY PRACTICES (250/CASE) - 
  PROTECTED HEALTH INFORMATION ACCESS LOGS (250/CASE) - 
  PROTECTED HEALTH INFORMATION DISCLOSURE LOGS (250/CASE) - 
  PATIENT REQUEST FOR AMENDMENT OF HEALTH INFORMATION FORMS (100/CASE) - 
  PATIENT REQUEST FOR ACCOUNTING OF DISCLOSURES (100/CASE) - 
  PATIENT REQUEST TO INSPECT PROTECTED HEALTH INFORMATION FORMS(100/CASE) - 
  PATIENT REQUEST FOR CONFIDENTIAL COMMUNICATION FORMS (100/CASE) - 
  PATIENT REQUEST FOR RESTRICTIONS ON USE & DISCLOSURE FORMS (100/CASE) - 
  PROTECTED HEALTH INFORMATION TRACKING LOGS (100/CASE) - 
  AUTHORIZATION TO RELEASE INFORMATION FORMS (100/CASE) - 

 
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