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Get UPMC Authorization for Release of Protected Health Information

He purpose stated on this form. Only those items checked off or listed will be released. g Although applicable law may prohibit re-disclosure of these records, I understand that it is possible that the facility/person that receives the records may re-disclose the information, therefore (1) UPMC and its staff/employees have no responsibilty or liability as a result of an redisclosure and (2) such information would no longer be protected by the Privacy Rule. g My decision to revoke the Authorizati.

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