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Authorization for Use or Disclosure of Health Information Form
ICR 202401-0915-002 · OMB 0915-0334 · Object 138588801.
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Document Metadata
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
|---|---|
| File Title | Authorization for Use or Disclosure of Health Information Form |
| Subject | Authorizing HRSA to obtain medical records required for obtainng benefits in the Countermeasures Injury Compensation Program (CI |
| Author | HRSA |
| File Created | 2024-07-26 |
| Conversion State | partial |