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Get Firelands Authorization To Release Copies Of A Medical Record

E: 419-557-7435 Fax: 419-557-5738 North Coast Professional Group, LLC, dba Firelands Physician Group 1111 Hayes Ave., Sandusky, OH 44870 Phone: 419-557-5552 Fax: 419-557-7832 (Hospital Records Only) (Physician Office Records Only) Patient Information Patient Name: Date of Birth: Street Address: Medical Record Number: City/State/Zip:.

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