AUTHORIZATION TO RELEASE MEDICAL INFORMATION - Adventist Health
Adventist Health AUTHORIZATION TO RELEASE MEDICAL INFORMATION 8707F86-0623-8 – 1/2021 Page 1 of 2 PATIENT LABEL [ADVENTISTHEALTH:INTERNAL] AUTHORIZATION TO RELEASE MEDICAL INFORMATION *Indicates a REQUIRED field. Completion of this document authorizes the disclosure and use of health information about you. ................
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