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Medical Records Release Authorization Form

At times, you may want us to coordinate care with other providers, disclose your information, or request previous records from external institutions. In order to do this while respecting your right to privacy, you may complete the form below  with specific instructions on what information we are allowed to request and/or share, and whom we may communicate said information with.

Given the technical language needed for this document can be somewhat confusing, please feel free to contact us if you have any questions while filling it out. Simply call us at (301) 951-0320 and we will be happy to help you!

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