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Get the free Please OBTAIN my medical information from: Memorial Care Imaging Center San Clemente...

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Account # 24411 Health Center Dr. ×200C, Laguna Hills, CA 92653 * Phone#: 9498295500 ext. 102 Fax#: 9495819158 * Email: mammography ocwmg.com AUTHORIZATION TO RELEASE MEDICAL RECORDS FOR MAMMOGRAPHY
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To fill out the "Please Obtain My Medical" form, follow these steps:

01
Start by providing your personal information, including your full name, date of birth, and contact details.
02
Indicate the purpose of obtaining your medical records. Specify whether it is for personal use, insurance claims, legal proceedings, or any other relevant reason.
03
Specify the range of medical records you would like to obtain. You can request a specific period, such as the past year, or provide details of the specific medical conditions or treatments you want the records to cover.
04
If there is a specific medical facility or healthcare provider responsible for your medical records, mention their name and contact information.
05
Sign and date the form, confirming that the information provided is accurate and that you authorize the release of your medical records.

Who Needs "Please Obtain My Medical"?

01
Individuals seeking copies of their medical records for personal reference or for their own records.
02
Patients who require their medical records to provide accurate information for insurance claims or applications.
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Legal entities involved in legal proceedings where access to medical records is necessary for evidence or for assessing claims.
Note: It is important to consult with the respective medical facility or healthcare provider to ensure you are following their specific process for obtaining medical records.
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