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Panorama Pediatric Group, RLL
220 Linden Oaks, Suite 200
Rochester, NY 14625
(585) 3814848Request for Release of Medical Records
Patient Name ___Date of Birth ___Phone # ___Purpose of Disclosure:
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Go to the Panorama Pediatric Group website or contact them directly for the necessary forms.
02
Fill out the patient's personal information including name, date of birth, address, and insurance information.
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Submit the completed forms to the Panorama Pediatric Group either online or in person.
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Parents or legal guardians of children who require pediatric medical care
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What is panorama pediatric group in?
Panorama Pediatric Group is a pediatric medical practice.
Who is required to file panorama pediatric group in?
The administrators or owners of Panorama Pediatric Group are required to file.
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The purpose of Panorama Pediatric Group is to provide accurate financial information about the medical practice.
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Information about the practice's revenue, expenses, and any financial transactions must be reported on Panorama Pediatric Group.
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