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Get Tx 73115 2017-2024

Of Protected Health Information Patient Name Date of Birth Address Medical Records# Telephone # ( I hereby authorize Memorial Hermann Health System to release my records from the following facilities (please check ONLY facilities that apply): HOSPITALS: Memorial City NW/Greater Heights Southwest Northeast Hermann-TMC Katy Woodlands Southeast MHOSH Cypress Pearland Katy Rehab ) Sugar Land TIRR OUTPATIENT CENTERS: River.

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