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Get TX Methodist West Houston Hospital Request For Patient Records 2012-2024

I authorize: to release ALL BREAST IMAGING & REPORTS. ALL BREAST IMAGING & REPORTS MUST BE MAILED TO: Methodist West Houston Hospital Breast Center 18500 Katy Freeway Houston, Texas 77094 Patient Signature: Date: Below is for Methodist West Houston Hospital staff to fill out: Date: To: Fax: Call 832-522-0016 when ready for cour.

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