Print copyFLAT PDFWAIVER AND OTHER
Consent to Obtain / Release Protected Health Information (Spanish)
- Form number
- APD-39
- Revision
- August 11, 2017
- Completed by
- Provider and support coordinator
- Format
- PDF · 75 KB · flat, print and complete
- Source
- apd.myflorida.com/forms/APD-39_APD%20OGC%20HIPAA%20FORM%200012_SP.pdf
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Description
Revision August 11, 2017. Print copy PDF; the builder adds fields.
