Long Beach California Permission To Disclose Health Billing Information

State:
Multi-State
City:
Long Beach
Control #:
US-PRM-26
Format:
Word; 
Rich Text
Instant download

Description

This is a form signed by an individual who wants to grant permission for a health care provider or hospital to release their medical records and/or billing information to another individual other than the patient as is required by the Health Insurance Portability and Accountability Act (HIPPA).

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Long Beach California Permission To Disclose Health Billing Information