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Get Uk Medical Records Release Form 2018-2024

(for Use and Disclosure) Please fill out all sections or the form may be returned to you. Social Security Number: Date of Birth: Phone Number: Patient Name: Address: City: State: Type of Release ROI+ Zip: Paper CD Permission to discuss care Review records at UK (must make an appointment) Pick-up -- Phone number Send Information from: UK HealthCare facilities Send to: email address (for ROI+ USE ONLY) or address (if name / address is different from above) UK College of Dentistry UK St.

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