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Forms
- Authorization to release protected health information (PHI) (PDF)
- Authorization to release psychotherapy notes (PDF)
- Patient advocate designation (PDF)
- Health risk assessment (PDF)
- Fraud, waste and abuse form
- Removal of Previous Auth – English (PDF)
- Removal of Previous Auth – Spanish (PDF)
- Request for Accounting of Disclosures of PHI GR-69239-5 – English (PDF)
- Request for Accounting of Disclosures of PHI GR-69239-5 – Spanish (PDF)
- Auth to Release PHI GR-69126-5 – English (PDF)
- Auth to Release PHI GR-69126-5 – Spanish (PDF)
- Auth to Release Psychotherapy Notes GR-69127-5 – English (PDF)
- Auth to Release Psychotherapy Notes GR-69127-5 – Spanish (PDF)
- PHI Access Request GR-69238-5 – English (PDF)
- PHI Access Request GR-69238-5 – Spanish (PDF)