Get the free health.baltimorecity.govsitesdefaultFax this form to: (410) 244-1366 Referral Source
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Coronary Angiogram Referral Former adapted from:Fax the referral form to 18076845902 Referral form will not be accepted without a separate patient history and medication list (send with referral)
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This form is faxed to the Baltimore City Health Department.
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The individuals or entities specified by the Baltimore City Health Department are required to file this form.
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