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[PDF File]State of Florida Department of Health Office of Vital Statistics ...
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chapter 775, florida statutes. applicant’s name type or print first middle last (including any suffix) delivery address (include apt. no., if applicable) city state zip code home phone number relationship to registrant work phone number signature of applicant if attorney, provide bar/professional license no. if attorney , provide name of ...

[PDF File]APPLICATION FOR A FLORIDA BIRTH RECORD
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APPLICATION FOR A FLORIDA BIRTH RECORD ALTERNATE PHONE NUMBER HOME PHONE NUMBER FATHER'S / PARENT’S NAME FIRST SECTION B: APPLICANT (adult requesting certificate) INFORMATION SIGNATURE OF APPLICANT IMPORTANT INFORMATION Any person who willfully and knowingly provides any false information on a certificate, record or report required by Chapter 382, Florida …

[PDF File]Healthcare Inspection Alleged Inappropriate Surveillance James …
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Alleged Inappropriate Surveillance, James A. Haley Veterans’ Hospital, Tampa, Florida . On August 2, 2012, Senator Bill Nelson (D-Florida) wrote to VA’s Inspector General. 1: I’m seeing news reports on the use of a hidden camera in the room of at least one patient at the James A. Haley VA Medical Center. The Tampa Bay Times

[PDF File]Medical release authorization
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Patientís last 4 Number of Social Security No. Medical Record No. Representative Name Relationship to Patient Representative Address Legal Authority Verification of Identity Verfication of Authority Form# 1107-001 (rev 1/12) Authorization to Records Custodian for the Release of Medical Records 13330 USF Laurel Drive, MDC 33 Phone (813) 974-9818

[PDF File]Tampa HCA Shared Service Center - Largo Medical Center
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Authorization for Patient Label (optional) USB drive, CD/DVD) Yes Tampa HCA Shared Service Center –HSC Release of Information 6451 126th Avenue North, Largo, FL 33773 Phone (866) 463-7272 Email: HSCT.MRRequest@Parallon.com

[PDF File]Request for Access and Authorization for Use and/or Disclosure …
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Florida Hospital Health Information Management . Release of Information . 3100 E. Fletcher Ave. Tampa, Fl. 33613 . Phone 813-615-7292 Fax: 813-615-8337 . You have the right to complain to the Office of Civil Rights. The following is the contact information: Office of Civil Rights ~ U S Department of Health & Human Services 61 Forsyth Street, SW ...

[PDF File]43RD ANNUAL EDUCATION CONFERENCE
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Tampa General Hospital Tampa, FL Cheryl Love, RN, BSN, BS-HCA, MBA, LHRM, CPHRM Director of Quality and Patient Safety Florida Hospital Association Orlando, FL Kimberly Stockdale, MSPH Regional Environmental Epidemiologist Food and Waterborne Disease Program Florida Department of Health Tallahassee, FL Chaz M. Rhone, MPH, CIC FPIC President

[PDF File]Request for Access to Protected Health Information by Individual …
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A503PT Rev. 9/22/16 *See reverse side for frequently asked questions. A503PT* Health Information Management Dept. P.O. Box 1289 Tampa, FL 33601-1289 Phone: (813) 844-7533 Request for Access to Protected Health Information by Individual Patients

[PDF File]Hillsborough County Trauma Agency Uniform Trauma Transport …
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The public safety call taker may also require a call back number. Generally, wireless phone calls provide the 9-1-1 system with the caller’s phone number and longitude, latitude coordinates, but the call taker still obtains location and call back numbers from all cellular callers. C. A special needs registry is maintained in conjunction with ...

Florida hospital tampa phone number