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AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATIONOasis Hospital 750 N. 40th Street, Phoenix, AZ 85008 Phone 6027977788 Fax: 6027977787 PATIENTS NAMEBIRTHDATEADDRESSZIPPHONE #DATES OF HOSPITAL SERVICE

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r oasis hospital 750 is a form used to report data on patient assessments and outcomes for patients receiving home health care services.

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