Hackensack medical center medical records

    • [PDF File]Authorization for Release of Information

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      I authorize Hackensack Meridian Health Medical Group to obtain records from: _____ (Name of provider and address) This authorization applies to the following information: ____ Complete Medical Record ... If the records are so protected, federal regulations may prohibit you from making further

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    • [PDF File]Hackensack University Medical Center Standard Operating ...

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      Hackensack University Medical Center Standard Operating Procedures Human Research Protection Program (HRPP) January 30, 2017

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    • [PDF File]HACKENSACK UNIVERSITY MEDICAL CENTER …

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      Hackensack University Medical Center and Regional Cancer Care Associates, LLC. Treatment dates: Past, current and future medical records as needed to provide your care Purpose of Request: To provide you with the highest quality of care.

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    • [PDF File]MERIDIAN HEALTH

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      Bayshore Community Hospital Jersey Shore University Medical Center Ocean Medical Center Riverview Medical Center Southern Ocean Medical Center Meridian Health Partner Other Meridian Facility (specify)_____ I a M a H a 4/ /#4"*. 2 ...

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    • HACKENSACK UNIVERSITY MEDICAL CENTER

      HACKENSACK UNIVERSITY MEDICAL CENTER 30 Prospect Avenue, Hackensack, New Jersey 07601 551-996-2000 ... or records related to Drug or Alcohol Abuse. ... address and date of birth. The notification should be sent to Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601 ATTN: Legal/Regulatory Department. I understand that such

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    • [PDF File]CUSTOMER INNOVATION STUDY Hackensack University …

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      CUSTOMER INNOVATION STUDY Hackensack University Medical Center gets one step closer to precision medicine with cloud-based Infor Cloverleaf Integration Suite + We are trying to understand human beings. So in order to do research, understand the data, and the information, we have to have access to the raw data.

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    • [PDF File]AUTHORIZATION TO USE OR DISCLOSE PROTECTED HEALTH …

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      AUTHORIZATION TO USE OR DISCLOSE PROTECTED HEALTH INFORMATION I hereby authorize use or disclosure of the named individual’s health information as described below Patient Name Date of Birth Social Security Number Address (Street, City, State, Zip Code) Telephone Number

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