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Get AL East Alabama Medical Center Patient Authorization Disclosure For Protected Health Information 2016-2024

AuthorizationtoDiscloseProtectedHealthInformation TheundersignedauthorizesEastAlabamaMedicalCenter2000PepperellPkwyOpelika,AL36801 Phone:3345282261Fax:3345282243 toreleasemyhealthinformationasnotedbelow:PatientInformationPatientFullName:.

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