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Two-Part Patient Disclosure Authorization HIPAA Form

Two-Part Patient Disclosure Authorization HIPAA Form, 8 1/2 x 11"

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$43.35
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JDF-DIS100-2-50
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Description

Protect your practice and avoid privacy disputes with this clear, step-by-step form authorizing release of patient information. Personalization includes: Includes your imprinted practice name, address, and phone number, up to 5 lines. 2-part form provides a patient copy and a 2-hole punched permanent record. SIZE: 8 1/2 x 11"

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