Personal medical records forms
[DOC File]Authorization for Release of Confidential Medical Records
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Authorization for Release of Confidential Medical Records. All sections of this authorization must be completed for the release of medical information. The release of records may be subject to a charge. …
[DOCX File]Informed Consent Document Template and Guidelines
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Some of these records could contain information that personally identifies you. Reasonable efforts will be made to keep the personal information in your research record private and confidential but absolute …
[DOC File]My Medication Record - AARP
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My Personal Information How to Use This Guide Name • Save this document to your PC. • Edit the copy on your PC to keep track of your medications (including prescription drugs, over-the-counter drugs, …
[DOC File]`Personal Physician [frm]
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PERSONAL PHYSICIAN REQUEST. I request the use of my personal physician in the case of occupational injury/illness. This physician has previously treated me and retains my medical records. Your personal …
[DOC File]Authorization to use and disclose personal health ...
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Signature of Personal Representative of the Patient Date. Printed Name of Personal Representative of the Patient and Relationship to Patient. Signature of Person Collecting Authorization Date. Printed …
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