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South Miami Women's Health, LLC 7000 SW 62nd Avenue, Suite 350, South Miami, FL 33143 Telephone: (305) 6659644 Fax (305) 6658884 AUTHORIZATION TO DISCLOSE HEALTH INFORMATION Patient Name: ID Number:
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Women's Health Clinic South Miami is a healthcare facility that specializes in providing medical services and support for women's health issues, including reproductive health, prenatal care, and wellness services.
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Information that may need to be reported includes patient demographics, health history, services rendered, outcomes, and any relevant statistical data essential for health monitoring and clinic operations.
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