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DE Authorization for Release of Protected Health Information

DE Authorization for Release of Protected Health Information

Use a DE Authorization For Release Of Protected Health Information 0 template to make your document workflow more streamlined.

This Authorization in writing at any time by sending the revocation to the State of Delaware Employee Health Care Plan Privacy Officer 97 Commerce Way Suite 201 Dover Delaware 19904 and that the revocation will be effective except to the extent that the Delaware Employee Health Care Plan and disclosed it is possible that the health information may be further disclosed by the recipient and no longer subject to protection under applicable federal privacy rules. Claim Number s Date s of Service...
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