Donald c. sheridan, m.d. 10213 n. 92nd street, suite 101 scottsdale, az 85258 phone: (480) 8606005 fax: (480) 8601882 patient name: dob: medical records request fee the office of donald c. sheridan, m.d., p.c., will provide your records to you...
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Subject: hedis 2011 data collection for unitedhealthcare and affiliated commercial, medicare and medicaid/chip plans (see enclosed faq for additional membership and plan information) dear physicians and health care professionals: we value our...
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Minnesota epilepsy group, p.a. 225 smith avenue north, suite 201, st. paul, mn 55102 phone: (651) 2415290 fax: (651) 2415248 authorization for the use and disclosure of protected health information patient name (last first middle) previous last...
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The pediatric center pc 126 morgan street stamford, ct 06905 hipaa authorization for release of patient records patient/patients name: i, , hereby authorize the pediatric center pc to release the medical health records: (please check one) copy of...
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