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PRIME CARE PEDIATRICS 15A Barnard Park, Newman, GA 30265 AUTHORIZATION FOR THE RELEASE OF PATIENT MEDICAL INFORMATION Phone: (770) 2515253; Fax: (770) 2515254 PLEASE COMPLETE ALL SECTIONS PATIENTS

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What is primecare pediatrics authorization for?

Primecare pediatrics authorization is for obtaining permission or consent for medical treatment or services for pediatric patients.

Who is required to file primecare pediatrics authorization for?

Parents or guardians of pediatric patients are required to file primecare pediatrics authorization.

How to fill out primecare pediatrics authorization for?

Primecare pediatrics authorization can be filled out by providing patient information, treatment details, and consent signatures.

What is the purpose of primecare pediatrics authorization for?

The purpose of primecare pediatrics authorization is to ensure proper permission is obtained for medical treatment or services for pediatric patients.

What information must be reported on primecare pediatrics authorization for?

Patient information, treatment details, and consent signatures must be reported on primecare pediatrics authorization.

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