PEACE CORPS Office of Health Services AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION

Peace Corps

This government document is issued by Peace Corps for use in U.S.

Add to Favorites
File Details: PDF (162 KB)
Downloads: 12
Source
https://files.peacecorps.gov/multimedia/pdf/returned/Authorization_For_Release_Of_Medical_information.pdf?_ga=2.176623781.1012552273.1653543496-924568152.1633580836

Have Questions About This Form?
Ask An Expert For Help:

Questions and comments are moderated. Minimum of 10 characters.

All questions and comments are moderated and publicly viewable. Please do not post private or sensitive information such as names, addresses, phone numbers, emails, confidential financial and legal details.

Login or sign up to submit questions