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Methodist University Health Center
5400 Ramsey Street
Fayetteville, NC 28311
MUHC@methodist.edu
(910) 6307164
(910) 6307544 name: ___
MU I'd #: ___
Date of Birth: ___AUTHORIZATION TO OBTAIN, RELEASE
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Request form page 1 is a document used to initiate a formal request or application.
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Any individual or entity needing to make a specific request or application may be required to file request form page 1.
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