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Get and Sign Medical Record Release Form University of Utah Health Care Healthcare Utah 2006-2022

Get and Sign Medical Record Release Form University of Utah Health Care Healthcare Utah 2006-2022

Use a Medical Record Release Form University Of Utah Health Care Healthcare Utah 2006 template to make your document workflow more streamlined.

UUHSC makes pursuant to this authorization may include information regarding my participation in a substance abuse treatment program. 6. Signature of UHC Staff Member Printed Name and Employee ID SUBSCRIBED AND SWORN before me this day of 20. 4P Form - Authorization.doc Rev 06/07/2006 RELEASE OF INFORMATION Emergency Records Immunizations Operative Report 4. Name Please disclose the following information circle to indicate your selection History and Physical Treatment Plans Psychological...
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