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Get Bcbs Standard Authorization Form

E Used or Disclosed (Please Complete Parts A and B in this Section) This Authorization CANNOT be used to disclose Psychotherapy Notes. Section III will assist in determining what PHI the individual identified in Section I allows the receiving person/entity identified in Section II to receive. This section has two parts, both of which must be completed. A. Release of Sensitive Protected Health Information Under State Law You must check yes or no if you authorize the release of medic.

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