![263366780-this-authorization-complies-with-the-hipaa-privacy-rule](https://cdn.cocodoc.com/cocodoc-form/png/263366780--This-authorization-complies-with-the-HIPAA-Privacy-Rule--x-01.png)
(This authorization complies with the HIPAA Privacy Rule)
Reset authorization for release of healthrelated information (this authorization complies with the hipaa privacy rule) name of proposed insured/patient (please print) date of birth i authorize any health plan, physician, health care professional,...
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