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HIPAA Privacy Authorization Form Authorization for Use or Disclosure of Protected Health Information Required by the Health Insurance Portability and Accountability Act 45 C. F*R* Parts 160 and 164 I authorize healthcare provider to use and disclose the protected health information described below to individual seeking the information. 2. Effective Period This authorization for release of information covers the period of healthcare from OR b. all past present and future periods. 3. Extent...
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