# REGIONAL MEDICAL CENTER RM1679766

FORM AUTH USE/DISCLOSURE PHI, SP 9090S 8/2020; FORM AUTH USE/DISCLOSURE PHI, 9090 08/2020; FORM AUTH USE/DISCLOUSRE P...

**Recipient:** 5003980 RR DONNELLEY

**Award Amount:** $637.50
**Ceiling:** $637.50

**Awarded:** June 03, 2026

**Identifier:** RM1679766

This order from REGIONAL MEDICAL CENTER, a California public hospital, to vendor 5003980 RR DONNELLEY includes the procurement of multiple forms related to authorized use and disclosure of protected health information (PHI). The total contract value is $637.50. The purchase covers three line items: Form Authorization for Use/Disclosure PHI SP 9090S 8/2020, Form Authorization for Use/Disclosure PHI 9090 08/2020, and Form Authorization for Use/Disclosure PHI V 9090V 8/20, with minimum order quantities specified. The order was placed on June 3, 2026.

### Description

FORM AUTH USE/DISCLOSURE PHI, SP 9090S 8/2020; FORM AUTH USE/DISCLOSURE PHI, 9090 08/2020; FORM AUTH USE/DISCLOUSRE PHI, V 9090V 8/20 (MINIMUM ORDER 15 PKS)