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RECORD RELEASE REQUEST FORM DATE: To: Ana M. Lamas, M.D. Medical Records DepartmentPatients name: DOB: ** I HEREBY AUTHORIZE Lamas Medical Center TO RELEASE MY RECORDS TO: TO: PHONE # *Office Notes:

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What is record release request form?

Record release request form is a document used to request the release of specific records or information.

Who is required to file record release request form?

Anyone who needs access to specific records or information may be required to file a record release request form.

How to fill out record release request form?

To fill out a record release request form, you typically need to provide your contact information, details of the records you are requesting, and any relevant information supporting your request.

What is the purpose of record release request form?

The purpose of a record release request form is to authorize the release of specific records or information to the individual or entity making the request.

What information must be reported on record release request form?

The information that must be reported on a record release request form typically includes the requester's name, contact information, details of the records being requested, and any other supporting documentation.

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