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Permian Basin Forms

Authorization for Release of Patient Information

Midland Clinic	English
Odessa Clinic	English
Odessa Tanglewood Clinic	English

Business Associate Agreements for Contracts

Business Associate Agreements for Purchase Orders

HIPAA Security Amendment

(For all agreements executed before April 21, 2005)

Confidential Communication Request	English	Spanish
Consent to Treatment	English	Spanish
Complaint	English	Spanish
Request for Accounting	English	Spanish
Request to Amend PHI	English	Spanish
Release for Media Purposes	English	Spanish

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