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 California Authorization Use Form 2018-2023

California Authorization Use Form 2018-2023

Use a california hipaa release form 2022 2018 template to make your document workflow more streamlined.

Information (the “Recipient”)? Recipient’s name and address: Recipient’s relationship to the Member: 3. What information may be disclosed to the Recipient? (Check one) Blue Shield of California is an independent member of the Blue Shield Association A46163 (2/18) c A  ny or all information Blue Shield maintains. This may include information relating to the Member’s medical care, diagnosis, providers, insurance or benefit claims/payments, and/or financial/billing information. This does not...
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