PROJECT FIONIGAN
PUBLIC DE-IDENTIFIED FLAT SOURCE FILE

SOURCE ID: SRC-FED-RELEASEAUTH-001
TITLE: De-identified flat source summary - federal specialty record-release authorization source
SOURCE TYPE: Private medical-record release authorization form

PUBLIC STATUS:
This is a de-identified source-trace summary.
The raw source document is held privately and is not deployed on the public website.
This file is plain text. It has no Project Fionigan overlay.

WHAT THIS SOURCE SUPPORTS:
- The private form is a medical-record authorization for release of federal specialty clinical records to a federal compensation-program recipient.
- The form requests release of broad clinical-record categories, including clinical notes, diagnostic testing, radiology, pathology, laboratory results, and other specified material over a defined period.
- The raw form contains recipient information, address/fax details, form fields, date-range fields, and authorization language.
- This source supports the public source map by documenting that federal specialty records were being routed to the compensation-record chain.

WHAT WAS REMOVED OR GENERALIZED:
- person names
- direct email addresses
- phone numbers
- street addresses
- exact private visit dates and times
- private provider/staff names
- private facility names
- patient identifiers and record identifiers
- birth-date and demographic identifiers
- payer / insurance identifiers
- signatures, browser/mail metadata, and handwriting identifiers
- raw clinical tables, raw screenshots, and full document text

RAW SOURCE:
Private / not deployed.

END OF PUBLIC DE-IDENTIFIED FLAT SOURCE FILE