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Get Phc-mr091 Regional Authorization For The Release Of Health Records R Aug 26-15.doc

AUTHORIZATIONFORTHERELEASEOFHEALTHRECORDS Pleasefaxormailyourcompletedrequesttoeachhospital/facilityyouarerequestingrecordsfrom. ATTENTION:HealthInformationManagement,ReleaseofInformationOffice Part1.Patient/ResidentInformation.

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