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Dr. Shannon Pamela 1500 S. 48th St., Suite 510 Lincoln, NE 68506 Telephone: 4024050500 Fax: 4024050505 MEDICAL RECORD RELEASE FORM Patient Name Date of Birth I hereby authorize Complete Endocrinology
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402-405-0500 fax 402-405-0505 bmedicalb is a fax number for medical purposes.
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Patient information, diagnosis, treatment details, and any other relevant medical data must be reported on 402-405-0500 fax 402-405-0505 bmedicalb.
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