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.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés.
For your convenience, the complete English version of this form is attached below the Spanish version.
Phoenix Arizona Consentimiento para la divulgación del historial médico - Consent to Release of Medical History
State:
Multi-State
City:
Phoenix
Control #:
US-00460
Format:
Word
Instant download
Description
Free preview
How to fill out Consentimiento Para La Divulgación Del Historial Médico?
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