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Get TX Spine & Joint Physicians HIPAA Authorization For Use Or Disclosure Of Health Information

Ut how we may use and disclose your protected health information and when we need your written authorization to do so. This form is for use when such authorization is required and complies with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Standards. Print Name of Patient: Date of Birth: SSN: I authorize the following using or disclosing party:.

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