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Link to form
https://www.va.gov/vaforms/medical/pdf/10-0527_Choice_fill.pdf
Form number
10-0527
Row ID
5383
Form title
Request and Authorization to Release Protected Health Information to the Choice Program
Issue date
Revision date
Form administration
VHA
Number of pages
1
Deleted
False
Form name
Request and Authorization to Release Protected Health Information to the Choice/PC3 Program