Release of Information (ROI) Form

PLP acknowledges that Privacy & Security is part of dignified care, which this organization takes very seriously. Therefore, we are opting in to certain security measures that will protect patients data from unauthorized access. An ROI (Release of Information) gives your provider permission to share specific information with PLP. This information is required to apply for financial assistance.

PATIENT AUTHORIZATION FOR USE & DISCLOSURE (RELEASE OF INFORMATION)

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