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Public Hospital District No. 4 203 South Western Avenue, Onset, WA 98855 AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION Name: Date of Birth: Phone: FROM: PLEASE SEND TO: Name of Clinic/Organization/Provider

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What is public hospital district no?

Public hospital district no is a unique identification number assigned to a public hospital district.

Who is required to file public hospital district no?

Public hospital districts are required to file public hospital district no.

How to fill out public hospital district no?

Public hospital district no can be filled out by providing the required information on the designated form.

What is the purpose of public hospital district no?

The purpose of public hospital district no is to identify and track public hospital districts.

What information must be reported on public hospital district no?

Information such as the name, address, and contact details of the public hospital district must be reported on public hospital district no.

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