Jersey City New Jersey Authorization to Use or Disclose Protected Health Information
State:
Multi-State
City:
Jersey City
Control #:
US-3580
Format:
Word;
Rich Text
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.
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