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1612 Chapin Road Chapin SC 29036 Ph 803 345-3414 Fx 803 345-1672 A Lexington Medical Center Physician Practice ChapinFamilyPractice. I realize the authorization allows LMC Physician Practices to release any information to any of my insurers or physicians. These services may include pathology radiology emergency services and other special services ordered by my provider. Com Physician Network Authorization/Consent Form GENERAL AUTHORIZATION FOR TREATMENT/CONTACT I authorize physicians nurse...
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