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Authorization to Release Test Results to a Designated Third
The purpose of this form is to authorize Foundation Medicine to release patient information or test results to a designated third party.
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Authorization to Release Protected Health Information to a
Instructions: This form is to be used by a patient or legal representative to authorize the release of information to a third party (other than a family member
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Authorization for the Release of Records to Another
If you do not or are unable to provide authorization, your request will be processed, but release of records will be severely restricted to protect the privacy
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