Authorization to Release Medical Information - Oklahoma Heart Hospital
Oklahoma City, OK 73132 OR Fax Hospital- (405) 608-1557 Physicians- (405) 608-3838 Oklahoma Heart Hospital South Campus Health Information Management Department, 5200 E. 1-240 Service Rd Oklahoma City, OK 73135 OR Fax to (405) 628-6960 Form Revision # Form Changes OHHP-F497 (Rev. 6/16) Added 3rd party request ................
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