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W 298  Form

W 298 Form

Use a w298 form template to make your document workflow more streamlined.

That apply): PHI (other than mental health, substance abuse and HIV-related records) substance abuse treatment records** mental health records* HIV related information*** DSS application and documentation relating to benefits applied for, received or receiving other _______________________________________________________________________________________ (Please specify) • I understand that my refusal to sign will not affect my ability to obtain services or benefits from DSS. • I understand...
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