Anaheim California Children's Hospital Health Information Exchange Patient Authorization Withdrawal

State:
Multi-State
City:
Anaheim
Control #:
US-70406NMS
Format:
Word; 
Rich Text
Instant download

Description

This authorization can be used in the event that you have executed Form US-70406NMS which is an Authorization and you wish to withdraw said Authorization.

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Anaheim California Children's Hospital Health Information Exchange Patient Authorization Withdrawal