dhcf

Department of Health Care Finance - DHCF

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Authorization for Use and Disclosure of Private/Protected Health Information

Monday, January 13, 2020

Authorization for Use and Disclosure of Private/Protected Health Information

File SizeFile Size

Attachment(s):

Medical Authorization Form.pdf - 172.3 KB (pdf)

Medical Authorization Form (Fillable).pdf - 240.9 KB (pdf)