Your Community Health Center - Rolla - Primary Care ...
South Central Missouri Community Health Center. DBA Your Community Health Center. 1050 West Tenth Street, Suite 480. Rolla, MO 65401. 573-426-4455. Fax 573-426-4454. Release of Medical Information. I, _____, with a date of birth, _____, give my permission for _____ to give my medical records (as described on p. ................
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