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Home » Individual Forms
 
Item Name: Medical Records Release
Product Number: T120MR
Price: $14.99/ea
Qty: 
Description: This form is for the authorization for release of medical information. This form must be completed and signed by the patient/guardian in order for the provider to release the patient's medical records. Tablets of 100 single-sided forms, pre-punched and cut to fit into the patient file.


 
Medical Records Release


Note All forms and charts can be customized to meet your specific requirements. Please call 800-243-4675 for more information.

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Wisconsin Dental Association, 6737 West Washington Street, Suite 2360, West Allis, WI 53214
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