• US Legal Forms

Pennsylvania Children's Hospital Health Information Exchange Patient Authorization

State:
Multi-State
Control #:
US-70405NMS
Format:
Word; 
Rich Text
Instant download

Description

An authorization allowing a Children's Hospital to access your information and when necessary share your information with other providers through a Health Information Exchange (HIE) that expires in 1 year from the date of your signature.
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Pennsylvania Children's Hospital Health Information Exchange Patient Authorization