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Search results with tag "Authorization for the release of medical"

AUTHORIZATION FOR THE RELEASE OF MEDICAL ... - …

AUTHORIZATION FOR THE RELEASE OF MEDICAL ... - …

www.everettclinic.com

INSTRUCTIONS & IMPORTANT INFORMATION Please read all information and instructions before completing and signing the authorization form. THERE MAY BE A CHARGE FOR COPIES OF YOUR MEDICAL RECORD UNLESS YOUR COPIES ARE BEING SENT TO ANOTHER PHYSICIAN OR HEALTHCARE FACILITY. Many patients ask The Everett Clinic

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AUTHORIZATION FOR THE RELEASE OF MEDICAL …

AUTHORIZATION FOR THE RELEASE OF MEDICAL

www.everettclinic.com

10-009 7/13 INSTRUCTIONS & IMPORTANT INFORMATION Please read all information and instructions before completing and signing the authorization form.

  Medical, Release, Authorization, Authorization for the release of medical

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