Omaha Nebraska Consent to Release of Medical History

State:
Multi-State
City:
Omaha
Control #:
US-00460
Format:
Word; 
Rich Text
Instant download

Description

This form is a consent to the release of medical history. The patient authorizes the release of his/her medical history to the specified party within the consent release form. The form also provides that all prior authorizations are cancelled.
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Omaha Nebraska Consent to Release of Medical History