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Ascension Providence Rochester HospitalPatient name: Address: 1101 W. University Drive Rochester, MI 48307 2486525000City: State: Zip Code: Date of Birth: HIM #: AUTHORIZATION TO DISCLOSE HEALTH INFORMATION
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Ascension Providence is required for individuals who need to provide their medical information to Ascension Providence or a healthcare provider associated with Ascension Providence. It is typically required for new patients, visitors, and individuals seeking medical services from Ascension Providence. The form helps Ascension Providence maintain accurate and complete records, assess individuals' healthcare needs, and provide appropriate medical care and treatment. It is important to fill out Ascension Providence accurately and honestly to ensure the best possible healthcare experience and outcomes.
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