Protected health information

Results: 1924



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1NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION We typically use or disclose your medical information in the following ways. These descriptions do not list every permitted use or disclosure in each category.

NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION We typically use or disclose your medical information in the following ways. These descriptions do not list every permitted use or disclosure in each category.

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Source URL: www.umcno.org

Language: English - Date: 2018-08-14 12:48:27
    2SCMA MEMBERS’ INSURANCE TRUST AUTHORIZATION TO USE AND DISCLOSE PROTECTED HEALTH INFORMATION Member Name______________________________________________________ Date of Birth ___________________________ ID Number________

    SCMA MEMBERS’ INSURANCE TRUST AUTHORIZATION TO USE AND DISCLOSE PROTECTED HEALTH INFORMATION Member Name______________________________________________________ Date of Birth ___________________________ ID Number________

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    Source URL: www.scmamit.com

    Language: English - Date: 2012-08-10 08:57:49
      3Medi-Chair, LLC/Redman Power Chair 1601 South Pantano Road # 107 Tucson, AZ6684 AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION (Protected Health Information)

      Medi-Chair, LLC/Redman Power Chair 1601 South Pantano Road # 107 Tucson, AZ6684 AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION (Protected Health Information)

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      Source URL: www.redmanpowerchair.com

      Language: English
        4AUTHORIZATION FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION This section must be completed for all Authorizations. Patient Name: Birth Date:

        AUTHORIZATION FOR DISCLOSURE OF PROTECTED HEALTH INFORMATION This section must be completed for all Authorizations. Patient Name: Birth Date:

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        Source URL: bleckleymemorial.com

        Language: English - Date: 2017-03-30 11:23:17
          5Employee Benefits Division System Confidentiality Agreement I, the undersigned, reviewed and understand the following statements: • All groups, employee, member, and any other protected health information (PHI) are con

          Employee Benefits Division System Confidentiality Agreement I, the undersigned, reviewed and understand the following statements: • All groups, employee, member, and any other protected health information (PHI) are con

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          Source URL: www.dfa.arkansas.gov

          Language: English - Date: 2017-12-15 14:05:52
            6SAMPLE REPORT CARDIAC DNA INSIGHT® Protected Health Information PERSONAL DETAILS NAME SAMPLE PATIENT

            SAMPLE REPORT CARDIAC DNA INSIGHT® Protected Health Information PERSONAL DETAILS NAME SAMPLE PATIENT

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            Source URL: dobo5gei6fpxq.cloudfront.net

            Language: English
              7EBPA AMENDMENT REQUEST Purpose: This form is used for an individual’s request to amend protected health information in designated record sets that we maintain or that our business associates maintain for us. SECTION A:

              EBPA AMENDMENT REQUEST Purpose: This form is used for an individual’s request to amend protected health information in designated record sets that we maintain or that our business associates maintain for us. SECTION A:

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              Source URL: forms.ebpabenefits.com

              Language: English - Date: 2015-08-29 08:37:01
                8NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. The Health Insurance Por

                NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. The Health Insurance Por

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                Source URL: www.emoryhealthcare.org

                Language: English - Date: 2018-01-24 01:01:34
                  9SAMPLE REPORT CARRIER STATUS DNA INSIGHT® Protected Health Information PERSONAL DETAILS SAMPLE PATIENT PATIENT ID

                  SAMPLE REPORT CARRIER STATUS DNA INSIGHT® Protected Health Information PERSONAL DETAILS SAMPLE PATIENT PATIENT ID

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                  Source URL: dobo5gei6fpxq.cloudfront.net

                  Language: English
                    10PARTNERS HEALTHCARE NOTICE FOR USE AND SHARING OF PROTECTED HEALTH INFORMATION THIS NOTICE APPLIES TO ALL PARTNERS HEALTHCARE MEMBER ORGANIZATIONS DESCRIBED BELOW AND ON PAGES 7 & 8 THIS NOTICE DESCRIBES HOW MEDICAL INFO

                    PARTNERS HEALTHCARE NOTICE FOR USE AND SHARING OF PROTECTED HEALTH INFORMATION THIS NOTICE APPLIES TO ALL PARTNERS HEALTHCARE MEMBER ORGANIZATIONS DESCRIBED BELOW AND ON PAGES 7 & 8 THIS NOTICE DESCRIBES HOW MEDICAL INFO

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                    Source URL: www.partners.org

                    - Date: 2014-10-01 08:51:58