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Allergy Rheumatology Associates LLC Michelle Spuza-Milord M. D. F.A. C. R. Ginige Swanthri De Silva M. D. F.A. C. R. AUTHORIZATION FOR RELEASE OF CONFIDENTIAL INFORMATION TO ALLERGY RHEUMATOLOGY ASSOCIATES LLC Patient Name Date of Birth I hereby request and authorize you to release my records to Allergy Rheumatology Associates LLC as they may request for coordination of care. I understand that I may revoke this authorization at any time by submitting a written request. Patient Signature Date...
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