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Jamal. Ahmed, MD, FACCCardiacElectrophysiologyConsultants, LLCTraianM. Angel, MD, FACE 716JamesSt,Suite106,Syracuse,NY13203 O315.277.2707 www.epcuse.com F315.505.1665Authorization for Release of Information

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Step 1: Begin by entering your personal information such as full name, date of birth, and contact information in the respective fields on the form.

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Step 2: Specify the purpose of the release of information. Include details such as whether the information will be used for medical, legal, employment, or other purposes.

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