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Edmond Dermatology Clinic620 West 15th Edmond, OK 73013 Phone: (405) 3590551 Fax: (405) 3593061 Ins./Billing: (405) 3304827Michael D. John, M.D. Andrew R. John, M.D.MEDICAL RECORDS RELEASE FORM The
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Individuals who are requesting their own medical records from Brigham and Women's Hospital (BWH) may need the medical-records-release-bwh-englishpdf form.
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medical-records-release-bwh-englishpdf is a form used to authorize the release of medical records at Brigham and Women's Hospital in English.
Patients or their authorized representatives are required to file medical-records-release-bwh-englishpdf.
To fill out medical-records-release-bwh-englishpdf, one must provide personal information, specify the records to be released, sign and date the form.
The purpose of medical-records-release-bwh-englishpdf is to authorize the disclosure of medical information to a specified individual or organization.
Information such as the patient's name, date of birth, medical record number, requested information, recipient's name and address, and authorization signature must be reported on medical-records-release-bwh-englishpdf.
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