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RELEASEOFMEDICALINFORMATIONIherebyauthorizethereleaseofmedicalinformationfromthemedical record of: PatientName DateofBirth SocialSecurityNumber DaytimePhoneNumber InformationReleasedto:SpectrumInternalMedicinePLLCPhone(585)9225246Dr

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phone585922-5246 is a specific form or document related to telephone records.

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