Common Contracts
2 similar Use and Disclose Your Health Information contracts
CONSENT TO USE AND DISCLOSE YOUR HEALTH INFORMATIONUse and Disclose Your Health Information • May 24th, 2021
This form is an agreement between you, and the Family Guidance Center of Warren County. The word ''you" means you, your child, relative, or other person for whom you are a personal representative.
CONSENT TO USE AND DISCLOSE YOUR HEALTH INFORMATIONUse and Disclose Your Health Information • May 24th, 2021
This form is an agreement between you, and the Family Guidance Center of Warren County. The word ''you" means you, your child, relative, or other person for whom you are a personal representative.
