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Get College Park Family Care Center Authorization for Use/Disclosure of Protected Health Information 2014-2024

Ire one year from the above date unless I specify an expiration date: _________________________ (Expiration date of authorization) *PLEASE READ Fee Information: College Park Family Care Center contracts with DataFile Technologies to copy and provide all medical records requested from our office. DataFile Technologies reserves the right to charge the medical record state fee structure as set forth in the state statute. Copy charges plus postage will be invoiced to you from DataFile Technologies, .

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