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Al completar y firmar este formulario, se divulgará su información médica según usted lo. Autorizo que se divulgue la información específica de los registros médicos del niño(a). ○.Esta autorización para liberar información es voluntaria. Sé que no tengo que completar este formulario con el fin de recibir tratamiento. Al completar este documento usted autoriza la divulgación y el uso de su información médica. Únicamente la información descrita en este formulario podrá ser utilizada o divulgada como resultado de esta autor- ización. 2. Esta autorización es solamente para la transmisión de Información Protegida de Salud (PHI). Documentación que pueda indicar la presencia de enfermedades transmisibles o venéreas entre las que se incluyen enfermedades como la hepatitis, sífilis,.