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Authorization for Medical Treatment Session: (please list session) Student Name Parent Name(s) Complete Mailing Address Home phone number(s) Work phone numbers(s) Email Please name two people to contact
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Download medical and release is a form that authorizes the release of medical information.
Patients or their legal guardians are required to file download medical and release forms.
To fill out the form, provide your personal information and signature authorizing the release of medical records.
The purpose of download medical and release is to allow healthcare providers to share medical information for treatment purposes.
Information such as patient's name, date of birth, and specific medical records to be released must be reported on download medical and release.
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