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Get and Sign AppleCare Medical Records Request Form DOC
Indicated below Please change the expiration date to last for days. Treatment payment enrollment in any health plan is not conditioned on signing this authorization. Once these records are released the information is not protected by Navicent Health AppleCare Urgent Care and may potentially be re-disclosed by the party who received these records. I understand this Authorization can be revoked at any time according to Navicent Health AppleCare Urgent Care privacy practices. Navicent Health...
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