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Sheridan Memorial Hospital, Sheridan, WY Cardiopulmonary Rehab Department AUTHORIZATION TO RELEASE MEDICAL INFORMATION PLEASE PRINT CLEARLY Patient Name: Med Rec #: LAST Date of Birth: FIRST INITIAL
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The purpose of Sheridan Memorial Hospital Sheridan is to report healthcare data to the appropriate governing bodies for regulatory and statistical purposes.
Information such as patient demographics, medical procedures, diagnosis codes, and billing information must be reported on Sheridan Memorial Hospital Sheridan.
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