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Get and Sign Please Complete and Sign the Following Documents Before Faxingemail the ReferralAdmissions Packet Back to  Form

Get and Sign Please Complete and Sign the Following Documents Before Faxingemail the ReferralAdmissions Packet Back to Form

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Appropriate documentation to verify homelessness eligibility. F.R. PART 2 THE NEW YORK STATE DEPARTMENT OF HEALTH PUBLIC HEALTH LAW 18 AND THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT HIPAA 45 C. F.R. Pts. 160 164 and that redisclosure of this information to a party other than the one designated above is forbidden without additional written authorization on my part. Approximate Duration Length of time treatment/service is necessary Name of Licensed/Credentialed Provider Print...
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