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HIPAA Release Form

Please download the HIPAA Release Form by clicking the link below:

HIPAARELEASEFORMFILLABLE0830060842


To be completed by the senior or their acting Power of Attorney. Evidence of Power of Attorney must be provided for some services. We will let you know if/when that may be needed. All information shared with us is HIPAA compliant and will only be shared with providers with explicit permission from your patient or their Power of Attorney.