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Get Kids Fracture Care Authorization To Release Healthcare Information

Oo.com AUTHORIZATION TO RELEASE HEALTHCARE INFORMATION Patient s Name: Date of Birth: Address: City: State: Zip Code: I hereby authorize the release/request of copies and/or discussion of the specified information included in my medical records that are in your possession. I understand that record requests may take up to 5 business days to process. Furthermore, I understand that if my request lacks any of the information requested below, the processing time may be significantly delayed.

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