Application for Waiver of HIPAA Authorization

Application for Waiver of HIPAA Authorization *   **

* The DOC file format requires that you have Microsoft Word '97 or higher installed on your computer. If you do not, please use PDF format.
** The PDF file format requires that you have the Adobe Acrobat Reader installed on your computer. If you do not have this program installed, you may download and install a free copy by clicking the icon below: