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Emsellem, MD Medical Director John R

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The document is an authorization form for the release of medical records from Dr. Helene A. Emsellem's office, intended for a patient to allow their full medical records to be shared with another party for continued treatment. It includes sections for patient information, recipient details, and legal disclaimers regarding confidentiality, particularly concerning alcohol or drug abuse information.

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2024	4.8 Satisfied (57 Votes)
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2021	4.8 Satisfied (60 Votes)
2021	4.8 Satisfied (162 Votes)

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