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BP/DHHS Authorization for the Disclosure of Protected Health Information-Spanish

Access: BP/DHHS Authorization for the Disclosure of Protected Health Information-Spanish

Active Status: Active

Revision Date: Mar 24, 2026

Responsible Staff: Carla Lasley

Agency Owner: State of Nebraska

This form is listed under the following form categories:
  Case Services - Release, Consent, Referral

This form is listed under the following chapters:
  Benefits Orientation

Form Options