Print copyFLAT PDFWAIVER AND OTHER
Consent to Obtain / Release Protected Health Information
- Form number
- APD OGC HIPAA FORM 0012
- Revision
- August 11, 2017
- Completed by
- Provider and support coordinator
- Format
- PDF · 179 KB · flat, print and complete
- Source
- apd.myflorida.com/forms/APD%20OGC%20HIPAA%20FORM%200012.pdf
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Description
Revision August 11, 2017. Print copy PDF; the builder adds fields.
