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AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION (Print patients full name) (Street address) (City, state, zip code) Birth date (Mo/Day/Yr) Social Security Number Phone (Home) At the request of the
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Start by gathering all the necessary forms and documents required for primary care division.
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Carefully read through the instructions provided with the forms to understand the process and requirements.
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Individuals who require regular medical care and guidance for their overall well-being.
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