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RECORDS REQUEST FORMToProvidingFacility:___ ______FAX#: ___PHONE#:___Thisistoauthorizethetransferofmymedicalrecordstothebelownamedfacility. Pleasesendall:Mammographicimages Reports Ultrasound images

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Medical Records Officeva North is the central repository for all medical records related to patients in the northern region.

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All healthcare providers and facilities in the northern region are required to file medical records with Officeva North.

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