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RECORDS RELEASE FORM:Date: ___Patient\'s Name___Date of Birth___I authorize my xrays and dental records be sent to:Penn Avenue Family Dental Dr. Sara Cooper 5346 Penn Avenue S Minneapolis, MN 55419
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How to fill out records-request-formspdf - penn dental

01
Download the records-request-formspdf from the Penn Dental website.
02
Open the downloaded form using a PDF reader on your device.
03
Fill out the necessary information in the form, such as your name, contact details, and the specific dental records you are requesting.
04
Make sure to provide any additional required documentation or information mentioned in the form.
05
Double-check your entries to ensure accuracy and completeness of the information.
06
Save the filled-out form on your device.
07
Print a hard copy of the form if required, otherwise, you can proceed with the next steps.
08
Sign the form using your actual signature if necessary.
09
Submit the form to Penn Dental as per their instructions, which may include mailing, faxing, or delivering it in person.
10
Keep a copy of the submitted form for your records.

Who needs records-request-formspdf - penn dental?

01
Anyone who requires access to their dental records from Penn Dental would need to fill out the records-request-formspdf. This can include current patients who need copies of their records for personal use or for transferring to a new dental provider, as well as previous patients who require access to their past dental history for various reasons.

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The records-request-formspdf - penn dental is a form used to request dental records from the University of Pennsylvania School of Dental Medicine.
Any individual or entity requesting dental records from the University of Pennsylvania School of Dental Medicine is required to file the records-request-formspdf.
To fill out the records-request-formspdf, you must provide your personal information, details of the patient whose records are being requested, the purpose of the request, and any necessary authorization.
The purpose of the records-request-formspdf is to facilitate the request and release of dental records for authorized purposes.
The information typically reported on the records-request-formspdf includes details of the requesting individual, patient information, reason for the request, and any necessary authorization signatures.
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