Hospital Release Of Information Form

 Medical Release
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Category:
State:
Multi-State
Control #:
US-00562
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Description

This Medical Release authorizes the physicians, hospital and all medical attendants to furnish full and complete medical reports and information requested by the person signing to whomever such person designates in the agreement. This authorization also includes examination of all hospital records, x-ray film and furnishing of any information including opinions. This agreement is applicable to all states.

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