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AUTHORIZATION FOR DISCLOSURE OF MEDICAL INFORMATIONPatients Name Date of Birth Last First Misaddress Phone I hereby authorize:South Bay Respiratory Associates Sydney C. Choslovsky, M.D. Donald A.
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South Bay Respiratory Associates is a healthcare organization specializing in respiratory care and treatment for various respiratory conditions.
Individuals or healthcare providers who have received services or benefits from South Bay Respiratory Associates may be required to file.
To fill out South Bay Respiratory Associates forms, individuals should provide accurate personal and medical information as required by the specific forms.
The purpose of South Bay Respiratory Associates is to provide specialized care and management of respiratory diseases and conditions.
Information that must be reported typically includes patient demographics, medical history, treatment records, and billing information.
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