FillableFILLABLEWAIVER AND OTHER
Consent to Obtain or Release Protected Health Information
- Form number
- APD OGC HIPAA FORM 0012
- Revision
- May 2026
- Completed by
- Provider and support coordinator
- Format
- PDF · 149 KB · fill fields present
- Source
- apd.myflorida.com/services/docs/Consent%20to%20Obtain%20or%20Release%20Protected%20Health%20Information.pdf
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Description
Revision May 2026. Fillable PDF.
