mental health information strategy implementation plan 2006 pdf
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Date: 2011-05-14
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! ! ! , -. / 0 ! 1 2 2 3 3 4 5 6/ 0 ! 1 2 2 32. / 0 1 ! 2 4 5 6/ 0 1 23 3! 2 AUTHORIZATION TO DISCLOSE MENTAL HEALTH INFORMATION I hereby authorize the use or disclosure of informa tion from the mental health record of: Patient Name.
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