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I understand that the admissions process is confidential. I understand that if I refuse to sign this Authorization to release my complete medical record, the New Jersey Division of.I authorize and request the disclosure of all protected information for the purpose of review and evaluation in connection with a legal claim. This form is used to advise Medicare of the person or persons you have chosen to have access to your personal health information. Complete this form and send via certified mail, FedEx or UPS with Certified Death Certificate. By initialing, I authorize the release of the information pertinent to my case. Doc (73k)AAS‑23Pediatric Medical Day Care Inspection Informationpdf (25k). Under Federal HIPAA Privacy regulations, Psychotherapy Notes require a separate, discrete authorization. Care Plus NJ does not maintain psychotherapy notes. This means they can look into pre-existing conditions and medical issues that are completely unrelated to the personal injury claim at issue.