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NJ 07458 Ph: (201) 236-8282 Fx: (201) 236-0138 51 Route 23 South Riverdale, NJ 07457 Ph: (973) 831-5799 Fx: 973) 831-7422 Allergy Medical Release Form Request for Access PHI (Protected Health Information) The HIPAA Privacy Rule determines that Allergy & Asthma Specialists, P.C. may use or disclose PHI for our treatment, payment and healthcare operations without any consent or authorization from the patient except where an Authorization is specifically required or other special requirements app.

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