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DOMINIQUE BARRIER 2017 CLINIC RELEASE FORM Please read and sign Location: Organizer:Day star Farm, 455 County Road 579, Dingoes, NJ Day star Founder New Jersey Law, an Equestrian Area Operator is
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Dominique Barbier clinic release is a form that allows a patient to authorize the release of their medical records from the clinic.
Patients who wish to have their medical records released from Dominique Barbier clinic are required to file the clinic release form.
To fill out the Dominique Barbier clinic release form, the patient must provide their personal information, specify the medical records they want to release, and sign the authorization.
The purpose of Dominique Barbier clinic release is to allow patients to authorize the release of their medical records for various purposes, such as transferring to a new healthcare provider or providing records to insurance companies.
The Dominique Barbier clinic release form must include the patient's name, date of birth, contact information, specific records to be released, purpose of release, and signature.
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