![31435383-authorization-form-pdf-myphr](https://cdn.cocodoc.com/cocodoc-form/png/31435383--Authorization-Form-pdf-myPHR--x-01.png)
Authorization Form (.pdf) - myPHR
Sample authorization to use or disclose health information patient name: date of birth: 1. i authorize the disclosure of the above named individual's health information as described below. 2. the following individual(s) or organization(s) are...
FILL NOW