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Get BayCare Clinic Informed Consent for Release of Patient Health Care Information

C setting.  Medical Records  in relation to care provided within a hospital setting, to include Aurora BayCare Medical Center, as well as services rendered within a  Radiology Department, Anesthesia, Emergency Department or at any another facility are  maintained by the facility where the service  was provided.    1. PATIENT INFORMATION  Patient Name___________________________________ Patient Account #_________________ Date of Birth_____.

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