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EvansGynecology 465 N. Belief Rd, Suite 2E, Evans GA 30809 7068555510 7068557254 (fax) AUTHORIZATION TO RELEASE MEDICAL RECORDS To Dr. Date: Name: DOB: SSN#: Address: City, State, Zip: Telephone:
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The evansgyn-record releasedocx is a specific document used for recording and releasing information related to Evans GYN services.
Individuals or entities providing Evans GYN services are required to file the evansgyn-record releasedocx.
To fill out the evansgyn-record releasedocx, one must provide accurate details such as patient information, service dates, and specific notes as required by the guidelines.
The purpose of the evansgyn-record releasedocx is to ensure proper documentation and release of medical records associated with Evans GYN services.
The evansgyn-record releasedocx must report patient identification, nature of services provided, dates of service, and any relevant medical history.
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