PAS-101L Consent to Release Personal Information is available in multiple languages.
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Consent to Release Personal Information (PAS-101L) -English
Consent to release information concerning treatment history for the purposes of obtaining insurance benefits.
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Consent to Release Personal Information (PAS-101L) - Chinese
中文翻譯 (Chinese)Consent to release information concerning treatment history for the purposes of obtaining insurance benefits.
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Consent to Release Personal Information (PAS-101L) - Italian
Traduzione italiana (Italian)Consent to release information concerning treatment history for the purposes of obtaining insurance benefits.
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Consent to Release Personal Information (PAS-101L) - Haitian-Creole
Tradiksyon kreyòl ayisyen (Haitian Creole)Consent to release information concerning treatment history for the purposes of obtaining insurance benefits.
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Consent to Release Personal Information (PAS-101L) - Korean
한국어 번역 (Korean)Consent to release information concerning treatment history for the purposes of obtaining insurance benefits.
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Consent to Release Personal Information (PAS-101L) - Russian
Перевод на русский язык (Russian)Consent to release information concerning treatment history for the purposes of obtaining insurance benefits.
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Consent to Release Personal Information (PAS-101L) - Spanish
Traducción al español (Spanish)Consent to release information concerning treatment history for the purposes of obtaining insurance benefits.
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Consent to Release Personal Information (PAS-101L) - Yiddish
אידיש (Yiddish)Yiddish. Consent to release information concerning treatment history for the purposes of obtaining insurance benefits.
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