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Wanting Healing Arts Center 2330 NW Flanders St. Ste. 101, Portland, OR 97210 Phone: 5037018766 Fax: 5032415484MEDICAL RECORDS RELEASE FORM This authorization must be written, dated and signed by
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KYE Medical Records Release.docx is a document used to authorize the release of a patient's medical records to a designated individual or entity.
Typically, the patient or their legal representative is required to file the KYE Medical Records Release.docx to grant permission for the release of their medical records.
To fill out the KYE Medical Records Release.docx, you need to provide personal information such as your name, date of birth, and contact details, specify the records being requested, indicate the recipient of the records, and sign the document.
The purpose of KYE Medical Records Release.docx is to provide a formal authorization for healthcare providers to share a patient's medical information with specified third parties.
The information required on KYE Medical Records Release.docx includes the patient's demographic details, specific records requested, the timeframe of records, and the name and signature of the patient or authorized representative.
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