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  • Glen Rose Medical Center Authorization For Release Of Information To Family Members

Get Glen Rose Medical Center Authorization For Release Of Information To Family Members

AUTHORIZATION FOR RELEASE OF INFORMATION TO FAMILY MEMBERSPatient Name: Date of Birth: Many of our patients allow family members such as their spouse, parents or others to request medical or billing.

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4. Rose Medical Centre – 420 beds. The Rose Medical Centre in Denver is a general medical and surgical facility licensed for 420 inpatient beds.

Glenrose Rehabilitation HospitalServicesEmergency departmentNoBeds244Public transit accessKingsway/Royal Alex station14 more rows

In January 2009, the governance of Glen Rose Medical Center was transferred to the Somervell County Health Care Authority Board.

Identification and Characteristics Name and Address:Glen Rose Medical Center 1021 Holden Street Glen Rose, TX 76043Total Staffed Beds:16Total Patient Revenue:$62,673,997Total Discharges:292Total Patient Days:9129 more rows

Popular tradition holds that Jordan's wife, Annie R. Lewis Jordan, suggested the name Rose Glen, because the scenic countryside reminded her of her native Scotland.

Fill out the Medical Information Release(MIR) form and secure an approval for release directly from your attending physician and the Medical Director. MIR forms are also available at the Information and Concierge. 2. Submit the approved MIR form to the Medical Records Management Department (MRMD) for processing.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232