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Get Sutter Authorization Health 2019-2024

Ive*. *Note: If you re not the patient, you may be asked to provide supporting documentation to verify that you are authorized to make this request on behalf of the patient. Patient Information Name: Address, City, State, ZIP: Date of Birth: Phone: Email: Who do you want us to request your records from? Physician or Healthcare Provider Name: Address, City, State, ZIP: Phone: Fax: Where do you want these records to go? Note: We can release information only to who you authorize. Check this b.

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