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Get and Sign Disclosure Protected Form 2018-2022

Get and Sign Disclosure Protected Form 2018-2022

Use a authorization disclosure protected form 2018 template to make your document workflow more streamlined.

X-Ray CD Dates of service: __________________ to ___________________.  MRI Report  Entire Chart - Hospital  MRI CD  Entire Chart - Physicians Office  CT Scan Report  CT Scan CD  Films  X-Ray Paper Copies  Other Please specify:_______________________________________  Clinic McBride Orthopedic Hospital is hereby authorized to make disclosures to:  Patient  Other individual  Organization No purpose is required when disclosure is being made to the patient. Purpose of release: ...
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