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Get UCHealth HIM19000 2018-2024

# Broomfield Hospital Grandview Hospital Yampa Valley Medical Center Authorization to Disclose Protected Health Information Patient Name: Formerly Known As: Birth Date: Address: City/State: Zip: Phone #: Purpose of Request: Continuation of Care Personal Legal Insurance Other: I authorize release to:.

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Keywords relevant to UCHealth HIM19000

  • MRN
  • CSN
  • broomfield
  • GRANDVIEW
  • Yampa
  • HIV
  • FACESHEET
  • myhealthconnection
  • Bolded
  • revocation
  • Dissemination
  • radiological
  • Immunization
  • communicable
  • applicable
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