40072 - INTERACTIVE Authorization for Release of Health Information Pursuant to HIPAA
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Keywords:
consent, Public form, release of info, medical record release
Description:
Med. Record. - Downtown Campus. Spanish version is F81280, Somali version is F83948. Website printing only. Last revised: 06/21/2018. Last review: 5/2022. Contact: Cindy Nappa/Robin Claflin. Note - Added "radiology reports" and "other" per Heidi Noce.