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RELEASE OF RECORDS RECORDS TO BE RELEASED FROM Dr. Robert M. Delaney DDS 1121 South Higgins Avenue Missoula MT 59801 Fax 406-721-4893 Email rmdddsxray dr-delaney. I UNDERSTAND THAT THIS AUTHORIZATION MAY BE REVOKED BY ME AT ANY TIME PROVIDED THAT I DO SO IN WRITING UP TO THE EXTENT THAT THE DISCLOSURE HAD NOT ALREADY BEEN MADE. THE REVOCATION IS EFFECTIVE FROM THE TIME IT IS COMMUNICATED TO THE HEALTH CARE PROVIDER. IT IS MY INTENT THAT INFORMATION FURNISHED IS PROHIBITED FOR ANY PURPOSE...

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Records to be released are documents or information that are disclosed or made available to the public, authorities, or other parties upon request.

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Anyone who has custody or control of the records and is obligated by law or policy to release them.

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