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Request for Restriction of Use and Disclosure of PHI Template
Share this request for restriction of use and disclosure of protected health information with your patients to improve your medical services, optimize your internal processes and digitize your business.
AVAILABLE ON PLATINUM PLAN
This template is available in the PLATINUM plan, with many perks:
- Unlimited forms and surveys
- Conditional logic
- Collect online payments
- Send data into 30+ native app integrations
Join 1.5 million happy customers that build forms & surveys with 123FormBuilder
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