CY999 - Consent Release of Information Authorization Form

Department of Human Services

This government document is issued by Department of Human Services for use in Pennsylvania

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File Details: PDF (380 KB)
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Source
https://www.dhs.pa.gov/docs/For-Providers/Documents/Child%20Care%20Forms/CY999%20-%20Consent%20Release%20of%20Information%20Authorization%20Form.pdf

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