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Forms & Applications Trumansburg, NY Cayuga Addiction

Forms & Applications Trumansburg, NY Cayuga Addiction

Use a Forms & Applications Trumansburg, NY Cayuga Addiction template to make your document workflow more streamlined.

Written permission to share the information with other agencies programs or payers. PURPOSE OR NATURE FOR DISCLOSURE/RELEASE AND NAME OF ORGANIZATIONS DISCLOSING AND OBTAINING PERSONAL IDENTIFYING INFORMATION I consent to the disclosure of confidential information to and among the New York State Office of Alcoholism and Substance Abuse Services OASAS the OASAS-Certified treatment facility identified above and Payer / Managed Care Plan of my clinical treatment including information from the...
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