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Medical Record Release Form Available as PDF Barnabas Health Barnabashealth
Or required for the purpose stated above. Writing and present my written revocation to the Health Information Services department. I understand that this revocation will not apply to the extent that Clara Maass Medical Center has already taken action in reliance on this authorization. This authorization will automatically expire 120 days from the date of my signature unless I otherwise specify that this authorization will terminate on the following date or concurrently with the following event...
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