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Get Consent To Release Information - Methodist Health System

S of the patient s choosing. This will also be used for consent to leave telephone messages at the selected phone numbers. Many times we have patients whose family members call requesting medical information and legally we are not allowed to release that information without the patient s written consent. Please take a moment to ll out this form, and we will keep it on le in your chart. It will be in effect until such notice is given in writing stating otherwise. Please Print: I, , date of.

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