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AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS This authorizes C. Gunshot Fogbound, MD, PhD, P.A., 1601 Liberty Street, Suite A, Richmond, TX 77469, pH: 2813426962, Fax: 2813426963 to provide a copy,
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This authorizes c is a form used to authorize someone to act on behalf of another individual or entity.
Any individual or entity who wishes to authorize someone to act on their behalf.
The form must be filled out with the necessary information about the authorized individual and the actions they are authorized to take.
The purpose of this form is to legally authorize someone to act on behalf of another individual or entity.
The form must include details about the authorized individual, the actions they are authorized to take, and any limitations to their authority.
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