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ARIZONA COMMUNITY PHYSICIANS, P.C. AUTHORIZATION TO DISCLOSE MEDICAL INFORMATION PATIENT Name Account # Former Name (If any) Daytime Telephone Birth Date INFORMATION TO BE RELEASED FROM I hereby authorize
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Arizona Community Physicians P is a group of healthcare providers in Arizona.
All healthcare providers within the Arizona Community Physicians P network are required to file.
Arizona Community Physicians P forms can be filled out online or submitted through the mail.
The purpose of Arizona Community Physicians P is to provide quality healthcare services to the community.
Information such as patient demographics, medical history, insurance information, and treatment plans must be reported on Arizona Community Physicians P forms.
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