vet medical record template
Authorization for the Release of Medical Records
A photocopy of this authorization shall be deemed effective as an original. This authorization shall be effective for twelve (12) months from the date of
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Authorization to Release Veterinary Records
I release the veterinarian and staff from any legal responsibility or liability for the release of information to the extent indicated as authorized herein.
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Medical Records Release Form
AUTHORIZATION TO RELEASE / OBTAIN MEDICAL RECORDS. Owner Name Please return signed and completed form via fax to (607) 253-3293, email to vet-medrec
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