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Get VA HSC Release of Information - Richmond 2014

’s Representative: Date: Print Name of Patient’s Representative: Relationship to Patient: Updated 08/2014 Richmond Health Information Management Service Center (HSC) Release of Information 7300 Beaufont Springs Drive, Richmond, VA 23225 Phone: 804-267-2103 Toll Free: 877-302-7338 Instructions for Completing the AUTHORIZATION FORM These instructions were designed to help answer any questions that may arise when completing the Authorization Form for the Release of Protected Health Infor.

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