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Patagonia Regional Medical Center, 104 7th Street, Bay City, TX 77414 (phone: 9792415565 fax: 9792415567)RELEASE OF INFORMATION AUTHORIZATION Section A: This section must be completed for all Authorizations
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Section A in this section is used to collect personal information about the individual or entity filing the form.
Any individual or entity that is submitting the form is required to fill out Section A.
Section A should be completed by providing accurate and up-to-date personal information as requested on the form.
The purpose of Section A is to identify the filer and ensure that the information provided can be attributed to the correct individual or entity.
Section A typically requires information such as name, address, contact details, and other identifying information.
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