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Standard Authorization Form to Release Protected Health ...

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Protected Health Information (PHI) Use this form to authorize Blue Cross and Blue Shield of Texas (BCBSTX) to disclose your protected health information (PHI) to a specific person or entity. You may follow the instructions below or call the number listed on your Member ID card if you need help completing the form. You must complete the entire form.

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  Health, Information, Protected, Disclose, Bcbstx, Protected health information

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Transcription of Standard Authorization Form to Release Protected Health ...

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