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ABILENE CHRISTIAN UNIVERSITY MEDICAL & COUNSELING CARE CENTER AUTHORIZATION FOR THE DISCLOSURE OF RECORDS John H. Canada, M.D., Ph.D. Kyle Sheets, M.D. Shelby Hannigan, FNPC Phone: 3256742625 Fax:
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wwwpdffillercom12044768-release-medical online acu authorization is a form used to authorize the release of medical information.
Patients or individuals who wish to authorize the release of their medical information are required to file wwwpdffillercom12044768-release-medical online acu authorization.
To fill out wwwpdffillercom12044768-release-medical online acu authorization, you need to provide your personal information, the medical information you want to release, and sign the form.
The purpose of wwwpdffillercom12044768-release-medical online acu authorization is to grant permission for the release of medical information to a specified individual or entity.
The information that must be reported on wwwpdffillercom12044768-release-medical online acu authorization includes details of the medical information to be released, the reason for the release, and the recipient of the information.
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