Document
Authorization for Use or Disclosure of Health Information Form
ICR 202001-0915-002 · OMB 0915-0334 · Object 97855601.
This document may belong to an older filing. More recent activity for OMB 0915-0334:
Document Viewer [doc]
Document Metadata
| File Type | application/octet-stream |
|---|---|
| File Title | Authorization for Use or Disclosure of Health Information Form |
| Author | rwalsh1 |
| Last Modified By | Writer |
| File Modified | 2016-08-24 |
| File Created | 2026-09-24 |
| Conversion State | complete |