HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 AUTHORIZATION FORM FOR HEALTH INFORMATION TO BE DISCLOSED TO DELGADO COMMUNITY COLLEGE (“DELGADO”) The status of the person whose health information is authorized for disclosure (check one): o Student o Student-Applicant o Employee o Employee-Applicant Name (please print): ________________________________________________________________ (The name of the person about whom the health information relates) Address: ...
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DELGADO FORMS 
