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AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION, hereby authorize San Juan Health Partners Aztec120 Llano St, Aztec, NM 87410 Telephone: (505) 3343404FAX: (505) 3343486To release the following information
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To fill out San Juan Health Partners form, follow these steps:
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Begin by writing your personal information such as full name, date of birth, address, and contact number in the designated fields.
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Provide your insurance information including the name of your insurance provider, policy number, and group number.
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Indicate the reason for your visit or the type of services you require from San Juan Health Partners.
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If you have any specific medical conditions or ongoing treatments, make sure to mention them.
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If you have any allergies or medications you are currently taking, disclose that information.
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Sign and date the form to certify that all the information provided is accurate.
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Double-check the form for any missing or incomplete information before submitting it.
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Submit the completed form to the appropriate department or healthcare provider at San Juan Health Partners.
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You may be required to schedule an appointment or follow additional instructions after submitting the form.

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San Juan Health Partners is a network of healthcare providers located in the San Juan County area.
Healthcare providers who are part of the San Juan Health Partners network are required to file.
To fill out San Juan Health Partners, providers need to provide accurate information about their medical practice and services.
The purpose of San Juan Health Partners is to improve healthcare coordination and access for patients in the San Juan County area.
Providers must report information such as patient demographics, services provided, and any quality measures or outcomes.
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