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MEDICAL RECORD RELEASE BRYAN MAR MEDICAL SPECIALISTS ASSOCIATION HEMATOLOGY/ONCOLOGY 825 OLD LANCASTER RD, STE 440 BRYAN MAR, PA 19010 P 6105254511 F 6105258561 SANDRA F. SHALL MD JOHN G. DEVLIN MD
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Enter your personal information accurately in the designated fields, such as your name, date of birth, and contact details.
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Provide the necessary medical information, including the dates of treatment, name of the healthcare provider, and reason for requesting the hemo records.
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Anyone who requires access to their hemo records will need to fill out the hemo records request formdoc.
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This may include patients who are changing healthcare providers, applying for medical research studies, or seeking a second opinion.
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The formdoc ensures that the necessary authorization and consent are obtained before releasing the hemo records to the requesting party.
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The hemo records request formdoc is a document used to request access to or copies of medical records related to hemophilia or blood disorders.
Patients, healthcare providers, or authorized representatives seeking access to a patient's hematological records are required to file this form.
To fill out the hemo records request formdoc, provide your personal information, indicate the specific records requested, and sign the form to certify consent.
The purpose of the hemo records request formdoc is to ensure proper authorization and documentation for obtaining sensitive medical records.
The form must include the patient's name, date of birth, contact information, specific records requested, and the purpose of the request.
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