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Ucsf Health Information

Ucsf Health Information

Use a authorization release information template to make your document workflow more streamlined.

The following information will not be released unless you specifically authorize it by marking the relevant box es below Information pertaining to drug and alcohol abuse diagnosis or treatment 42 C. Release of genetic testing information Health and Safety Code 124980 j. EXPIRATION OF AUTHORIZATION Unless otherwise revoked this Authorization expires insert applicable date or event. If no date is indicated the Authorization will expire 12 months after the date of my signing this form. Print Name...
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