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Get Wellspan Doctors Note

Ress: I authorize the use / disclosure of health information about me as described below: to obtain from: disclose to: (What Organization) Address: (Release to What Organization / To whom) Address: The following information from my medical record (Please specify visit dates) From To Complete Medical Record or specific information as selected below: Abstract of Hospital Medical Record (History & Physical, Discharge Summary, Consultation Reports, Opera.

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