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AUTHORIZATION to PATIENTT INFORMATION 2019-2023
Release of Information 2000 Canal Street New Orleans LA 70112 To release information to Phone Number 504 702-2082 Fax Number 855 526-9216 UMCMedicalRecords lcmchealth. Redisclose my PHI to a third party. The third party may not be required to abide by this Authorization or applicable federal and state law governing the use and disclosure of my PHI. MRO Corporation Service Charge Paper 10 per page plus tax and postage Electronic 10 per page Electronic Delivery or CD Flat fee of 6. Org Myself...
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