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Authorization for the Disclosure of Protected Health Information - for the Purpose of Removal of Firearm Disability - Nebraska
Authorization for the Disclosure of Protected Health Information - for the Purpose of Removal of Firearm Disability is a legal document that was released by the Nebraska Department of Health and Human Services - a government authority operating within Nebraska.
FAQ
Q: What is the Authorization for the Disclosure of Protected Health Information?
A: It is a document that allows the release of private health information.
Q: What is the purpose of the Authorization for the Disclosure of Protected Health Information?
A: It is for the removal of a firearm disability in Nebraska.
Q: What does the Authorization for the Disclosure of Protected Health Information require?
A: It requires the disclosure of certain health information for the evaluation of firearm eligibility.
Q: Who needs to complete the Authorization for the Disclosure of Protected Health Information?
A: Individuals who have a firearm disability that they wish to remove in Nebraska.
Q: What type of health information is disclosed with the Authorization for the Disclosure of Protected Health Information?
A: Relevant medical and mental health records that pertain to the individual's eligibility for firearm possession in Nebraska.
Form Details:
- Released on January 1, 2012;
- The latest edition currently provided by the Nebraska Department of Health and Human Services;
- Ready to use and print;
- Easy to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Nebraska Department of Health and Human Services.
