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Get HIPAA700A-F1 2003-2023

Ient identified below, and I am requesting the following laboratory test result(s) for that patient, which were ordered by another health care provider, be released to me solely for treatment purposes. (Note to Non-Ordering Health Care Provider; Quest Diagnostics relies on Information provided by the ordering clinician at the time the laboratory test is ordered. The information provided by the ordering clinician may not be sufficient to accurately match the information you provide on this reques.

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