San Bernardino California Request for an Individuals Health Information

State:
Multi-State
County:
San Bernardino
Control #:
US-3577
Format:
Word; 
Rich Text
Instant download

Description

This form is used by an individual to request access to his or her protected health information. The individual's rights regarding this access are also acknowledged by the individual.

How to fill out San Bernardino California Request For An Individuals Health Information?

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San Bernardino California Request for an Individuals Health Information