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Authorization to Disclose Protected Health Information (Copy of records takes 7 to 14 business days to process) PLEASE PRINT CLEARLY- You must provide full mailing address or this form will be returned
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Note: Please keep in mind that the content provided is for demonstration purposes only and may not accurately represent the website www.omnihealthcare.com.
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www.omnihealthcare.com is a website for a healthcare company providing information about healthcare services and facilities.
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