Get Release Of Records From Colorado Mountain Medical Form
PO Box 1749 Beard Creek Rd Suite 200 Edwards CO 81632 Phone 970 926-6340 Fax 970 926-6348 Authorization for the use of Disclosure of Protected Health Information As required by the Health Insurance Portability and Accountability Act of 1996 Colorado Mountain Medical PC may not use or disclosure your health information except as provided in our Notice of Privacy Practices without your authorization. Your signature on this form indicates that you a....
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