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This Form is used for authorizing the release of medical information in California.
This type of document is a "CT-11A Authorization for Delivery of Records form" in Spanish. It is used in the state of New Jersey for authorizing the delivery of records.
This Form is used for Disclosing Limited Health Information (HIPAA) - New York (Spanish).
Este formulario se utiliza para autorizar la divulgación de información médica o de salud a terceros en Tennessee. (Spanish)
This form is used for authorizing the disclosure of information in Texas.
This type of document is used to authorize the release of protected medical information to Ahcccs in Arizona.
This Form is used for authorizing Ahcccs to disclose protected health information about your health in Arizona. This document is in Spanish and has large font.