dhhs-1000-sp-ia DSB/ Authorization to Disclose Health Information -Spanish
Form Number | dhhs-1000-sp-ia |
Agency/Division | Services for the Blind (DSB) |
Policy Program | Special Assistance |
Form Effective Date | 2019-06-24T09:00:00-04:00 |
Form File | DSB Authorization to Disclose Health Information -Spanish.pdf |