Authorization to Release Protected Health Information to Identified Family/Support Members - VIETNAMESE [External] [External]

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atlas:atm_form_e5ef3d89864f3d38b1e8

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url: https://www.marinbhrs.org/sites/default/files/2021-10/Family%20Authorization%20-%20Vietnamese.pdf
host: marinbhrs.org
pages: 2
entity: ent-marin-hhs
fields: 0
nature: UNKNOWN
doc type: form
fillable: false
form kind: document
form object: https://miscsubjects.com/api/forms/form/frm_e5ef3d89864f
form object id: frm_e5ef3d89864f

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Source record updated 2026-10-15 00:36 UTC.

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{
  "url": "https://www.marinbhrs.org/sites/default/files/2021-10/Family%20Authorization%20-%20Vietnamese.pdf",
  "host": "marinbhrs.org",
  "pages": 2,
  "entity": "ent-marin-hhs",
  "fields": 0,
  "nature": "UNKNOWN",
  "doc_type": "form",
  "fillable": false,
  "form_kind": "document",
  "form_number": null,
  "form_object": "https://miscsubjects.com/api/forms/form/frm_e5ef3d89864f",
  "form_object_id": "frm_e5ef3d89864f"
}