Common use of Systematic Alien Verification for Entitlements (SAVE) Disclosure Clause in Contracts

Systematic Alien Verification for Entitlements (SAVE) Disclosure. I hereby authorize the release of Department of Homeland Security data pertinent to my immigration status to the Florida Department of Children and Families and [Provider Name] to access federal public benefits and/or Refugee Services-funded services. III Protected Health Information (PHI) Disclosure Protected Health Information (PHI) Disclosure I hereby authorize the release of my protected health information (PHI) to Refugee Services for the purpose of determining eligibility for services or special exemption from program requirements.

Systematic Alien Verification for Entitlements (SAVE) Disclosure. I hereby authorize the release of Department of Homeland Security data pertinent to my immigration status to the Florida Department of Children and Families and [Provider Name] to access federal public benefits and/or Refugee Services-Services- funded services. III Protected Health Information (PHI) Disclosure Protected Health Information (PHI) Disclosure I hereby authorize the release of my protected health information (PHI) to Refugee Services for the purpose of determining eligibility for services or special exemption from program requirements.

Systematic Alien Verification for Entitlements (SAVE) Disclosure. I hereby authorize the release of Department of Homeland Security data pertinent to my immigration status to the Florida Department of Children and Families Families/Refugee Services Program and [Provider Name] to XXXXXXX .to access federal public benefits and/or Refugee Services-funded services. III Protected Health Information (PHI) Disclosure Protected Health Information (PHI) Disclosure I hereby authorize the release of my protected health information (PHI) to Refugee Services for the purpose of determining eligibility for services or special exemption from program requirements.