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Authorization to Disclose Protected Health Information
Authorization to Disclose Protected Health Information
Please print this Authorization to Use or Disclose Protected Health Information form, complete it using black or blue pen, and return it to Family Health Center of Worcester at your earliest convenience.
Click here to download the form.
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Family Health Center of Worcester | 26 Queen Street, Worcester, MA 01610 | 508-860-7700 | TTY 508-860-7750
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