
Authorization to Release Protected Health Information Mental Health Treatment I, Name of Patient/Client , whose Date of Birth is , authorize Tyler Beach, LCSW to disclose to and/or obtain from: the following information: Name of Person or
Authorization to release protected health information mental health treatment i, name of patient/client , whose date of birth is , authorize tyler beach, lcsw to disclose to and/or obtain from: the following information: name of person or title of...
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