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Panorama Pediatric Group, RLLP Medical Records Release Patient s First Name Patient s Last Name Patient s Date of Birth Handy-carry/pick-up records Authorization to give/get records with medical office.

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  1. Open the template in the full-fledged online editing tool by hitting Get form.
  2. Complete the requested boxes which are yellow-colored.
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  5. Insert the date.
  6. Double-check the whole e-document to ensure that you have not skipped anything.
  7. Hit Done and download your new form.

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