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Fax: (845) 704 6173 Phones: (845) 225 3400 75 Seminary Hill Road Carmel, NY 10512 MR Number Patient Name: AUTHORIZATION TO RELEASE INFORMATION FROM THE PATIENT RECORD PATIENT NAME DATE OF ADMISSION
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What is 845 225 3400?
845 225 3400 is a form used for reporting certain information to the relevant authorities.
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