Contra Costa California Autorización para la divulgación de información personal - Authorization for Release of Personal Information
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How to fill out Autorización Para La Divulgación De Información Personal?
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FAQ
La autorizacion proporcionada al usar el formulario significa que la organizacion, entidad o persona autorizada puede divulgar, comunicar o enviar la informacion medica protegida de la persona nombrada a la organizacion, entidad o persona identificada en el formulario, inclusive usando cualquier metodo electronico.
Autorizacion para Divulgar Informacion divulgar mi informacion de salud individualmente identificable a las siguientes personas u organizaciones: Escriba el nombre y la direccion de cada persona que usted autorice a Optum a divulgar informacion relacionada con su atencion.
Un Formulario de Divulgacion Financiera es un formulario que es solicitado por el tribunal y que se requiere en cualquier caso de Ley de Familia relacionado con asuntos de divorcio o custodia de menores.
