Authorization to Use or Disclose Protected Health Information Form (Release of Information - ROI)

Shasta County Office

This government document is issued by Shasta County Office for use in Shasta County, CA

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File Details: PDF (265 KB)
Downloads: 9
Source
https://www.shastacounty.gov/sites/default/files/fileattachments/health_amp_human_services_agency/page/3280/authorization-form_2019-04-109e979c226bfb69248dc7ff0000cdcf8f.pdf

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