|
GCI-1020AS |
Authorization to Disclose Protected Health Information (Spanish) |
06/01/2020 |
|
FAA-0837A |
Authorization to Open an IDA |
06/01/2023 |
|
DES-1059A |
Authorization to Release Information (English/Spanish) |
09/01/2018 |
|
APS-1032A |
Authorization to Release Non-HIPAA Information Form |
08/01/2023 |
|
DDD-2149A |
Authorization to Release Records |
08/01/2022 |
|
RSA-1365A |
Authorization/Consent for Disclosure and Use of Confidential Information Between DDD and RSA (English) |
08/01/2024 |
|
RSA-1365A-S |
Authorization/Consent for Disclosure and Use of Confidential Information Between DDD and RSA (Spanish) |
08/01/2024 |
|
RSA-1365A-LP |
Authorization/Consent for Disclosure and Use of Confidential Information Between DDD and RSA - Large Print (English) |
08/01/2024 |
|
RSA-1365A-SLP |
Authorization/Consent for Disclosure and Use of Confidential Information Between DDD and RSA - Large Print (Spanish) |
08/01/2024 |
|
FAA-1494A |
Authorized Representative Removal |
05/01/2023 |