Orange California Autorización de Uso y/o Divulgación de Información de Salud Protegida - Authorization for Use and / or Disclosure of Protected Health Information
Category:
State:
Multi-State
County:
Orange
Control #:
US-178EM
Format:
Word
Instant download
Description
Este formulario permite que un empleado autorice los tipos de información médica que debe divulgar el departamento de recursos humanos.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés.
For your convenience, the complete English version of this form is attached below the Spanish version.
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