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AUTHORIZATION FOR RELEASE OF INFORMATION TO ANOTHER PRACTICE (Please print clearly)RELAX TO: 7243786650Paper copies Note that there will be a charge for the cost associated with copying your records
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Begin by providing your personal information, including your full name, date of birth, address, and contact details.
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Move on to the medical history section where you'll be asked to provide information about any pre-existing conditions, allergies, medications, and surgeries.
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Home Heritage Valley Health is a form used to report information about medical conditions, treatments, and health care providers.
Patients or individuals receiving health care services are required to file Home Heritage Valley Health.
Home Heritage Valley Health can be filled out online or submitted through mail with information about medical history, current treatment, and health care providers.
The purpose of Home Heritage Valley Health is to provide accurate information about a patient's health status and medical treatment.
Information such as medical conditions, medications, allergies, surgeries, and contact information for health care providers must be reported on Home Heritage Valley Health.
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