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FMLA/DISABILITY AUTHORIZATION The undersigned authorizes The Orthopedic Clinic to release my health information as noted below. Phone 3862554596 | Fax 3862546819Patient Information *Please Print*
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Return form completed release is a document that is used to report completed activities or projects in order to release any outstanding obligations or liabilities.
Any individual or organization that has completed a project or activity and needs to formally notify the involved parties that there are no more outstanding obligations or liabilities.
To fill out a return form completed release, one must provide details about the completed activities or projects, list any outstanding obligations or liabilities, and sign the form to certify its accuracy.
The purpose of return form completed release is to formally notify the involved parties that the activities or projects have been completed and there are no more outstanding obligations or liabilities.
Information such as details about the completed activities or projects, any outstanding obligations or liabilities, and the signature of the individual or organization certifying the accuracy of the information.
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