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REQUEST FOR AND AUTHORIZATION TO RELEASE PROTECTED .HEALTH INFORMATION TO eHEALTH EXCHANGE

ICR 201407-2900-009 · OMB 2900-0260 · Object 48733601.

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Document Metadata
File Typeapplication/octet-stream
File TitleREQUEST FOR AND AUTHORIZATION TO RELEASE PROTECTED .HEALTH INFORMATION TO eHEALTH EXCHANGE
SubjectRequest to release protected health information to eHealth Exchange
AuthorDepartment of Veterans Affairs Veterans Health Administration
File Modified2014-08-27
File Created2014-07-10
Conversion Statefailed_conversion