Mesa Arizona Autorización para usar o divulgar información de salud protegida - Authorization to Use or Disclose Protected Health Information
State:
Multi-State
City:
Mesa
Control #:
US-3580
Format:
Word
Instant download
Description
This form is used by an individual to consent to the use or disclosure of protected health information as described within. The individual also indicates the acknowledgment of his or her rights regarding consent to the use and disclosure of the information.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés.
For your convenience, the complete English version of this form is attached below the Spanish version.
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