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GOLDEN STATE ORTHOPEDICS & SPINE HEALTH HISTORY PLEASE COMPLETE THE FOLLOWING INFORMATION FOR REVIEW BY YOUR PROVIDER. Name: ___ Birth Date: ___/___/___ Age: ___ Height: ___ Weight: ___Sex: MF Dominant
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Fill in your personal information such as name, date of birth, address, and contact information in the designated fields.
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Sign and date the form to authorize the release of your medical records.
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gsos-med-rec-release-formpdf is a document used to release medical records in the GSOS system.
Patients or authorized representatives are required to file gsos-med-rec-release-formpdf to release medical records.
To fill out gsos-med-rec-release-formpdf, one must provide their personal information, specify the records to be released, sign and date the form.
The purpose of gsos-med-rec-release-formpdf is to authorize the release of medical records stored in the GSOS system.
On gsos-med-rec-release-formpdf, one must report their personal information, specify the records to be released, and provide authorization for the release.
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