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CMS 10106 Medicare Authorization to Disclose Personal Health Information Form
ICR 202305-0938-012 · OMB 0938-0930 · Object 132065001.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | CMS 10106 Medicare Authorization to Disclose Personal Health Information Form |
| Subject | Medicare Authorization to Disclose Personal Health Information Form |
| Author | Centers for Medicare and Medicaid Services |
| File Created | 2023-07-31 |
| Conversion State | partial |