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Authority for Release of Medical Information

Authority for Release of Medical Information
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Category: Releases - Medical - Authorizations
State:Multi-State
Control #:  US-00426
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Description

Patient authorizes the physicians, medical attendants, and the hospital to furnish full and complete medical information to the specified attorney at law, or to any representative or investigator from his/her firm. The form also provides that all prior authorization is cancelled.
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