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Consultants in Pain Medicine, P.A. h4p://www.cipm.com Raul G. Martinez, M.D. Panel Clark, R.N., FNPC Alexis JimenezDavila, R.N., FNPC AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS Patient Name: DOB:
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brelease medical record 2 is a form used to release medical information to authorized entities or individuals.
Patients or their legal representatives are required to file brelease medical record 2.
To fill out brelease medical record 2, provide your personal information, specify the authorized recipient of the medical records, and sign the consent form.
The purpose of brelease medical record 2 is to authorize the release of medical records to ensure continuity of care or legal purposes.
Information such as patient demographics, types of records being released, and the purpose for release must be reported on brelease medical record 2.
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HIPAA fnp bc Raul X-Rays Portability FX Fredericksburg TX MRI jimenez Alexis Anel cipm h4p davila ATTN DOB compliant Accountability governing enacted Consultants expire requiring Medications confidentiality

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