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Trumbull Mahoning Medical Group AUTHORIZATION TO USE AND/OR DISCLOSE HEALTH INFORMATION Requesting Records Copying Fee: $20 Print Names: DOB: I, authorize Trumbull-Mahoning Medical Group to use and/or
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Chart copying formdoc docx is a document used to request copying services for charts or graphs in a digital format.
Anyone who needs to make copies of charts or graphs in a digital format needs to fill out and file the chart copying formdoc docx.
To fill out chart copying formdoc docx, you need to enter your contact information, specify the number of copies needed, describe the charts or graphs to be copied, and indicate any special requests.
The purpose of chart copying formdoc docx is to facilitate the process of requesting and receiving copies of charts or graphs in a digital format.
The information that must be reported on chart copying formdoc docx includes contact information, number of copies needed, description of charts or graphs, and any special requests.
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