Tarrant Texas Permiso para divulgar información de facturación de salud - Permission To Disclose Health Billing Information
State:
Multi-State
County:
Tarrant
Control #:
US-PRM-26
Format:
Word
Instant download
Description
Formulario de firmas individuales que otorgan permiso para que el proveedor de atención médica divulgue información médica a las personas incluidas en la lista.
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.
How to fill out Permiso Para Divulgar Información De Facturación De Salud?
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