UChicago Medicine Ingalls Memorial Hospital Request and ...
University of Chicago Medical Center Other _____ Ingalls Memorial Hospital All UChicago Medicine Health System Locations UChicago Medicine Ingalls Memorial Hospital Request and Authorization for Medical Records Method of Delivery: ____ Mail ____Secure Portal - provide email_____ ____ Other (e.g. electronic): _____ April 2021 Section IV: SPECIFIC CONSENT PLEASE READ THIS PAGE … ................
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