AUTHORIZATION TO USE / DISCLOSE HEALTH INFORMATION
2019-10-09 · _____ Northwest Research Center. Name of Facility Kaiser Legacy OHSU VA Adventist . Attn: _____ Name of Physician _____ 6327 SE Milwaukie Avenue _ _____ Portland, OR 97202. Phone Number of Facility . 503-238-6233 (ph) 503-231-7668 (fax) The purpose for which these medical records will be used is for treatment in a research study. Would you kindly furnish them with the following … ................
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