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Consent to Release Medical Information Referral to a Children’s Resource Center for Children and Youth with Special Health Care Needs (CYSHCN)

Assigned Number Title Release Date File Type Language Available to Order
F-01238 Consent to Release Medical Information Referral to a Children’s Resource Center for Children and Youth with Special Health Care Needs (CYSHCN) 11/15/2023 PDF English No
F-01238S Consent to Release Medical Information Referral to a Children’s Resource Center for Children and Youth with Special Health Care Needs (CYSHCN), Spanish 11/15/2023 PDF Spanish No
Last revised April 19, 2024