Compound Release of Information  - HIPPA

UNITY HEALTH is authorize to release protected health information about the above named patient to the entittes named below. The purpose is to inform the patient or others in keeping wih the patients instructions. PERSON AUTHORIZED TO RECIEVE PROTECTED HEALTH INFORMATION ABOUT YOU: Please check eachperson/entity below that you approve to receive information.
I give authorization for the release of proteced health information n voicemail.
I give authorization for appointment reminders via text message.

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