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Release for medical records - Dr. Michael O. LaGrone, MD, PA

Release for medical records - Dr. Michael O. LaGrone, MD, PA 2025

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The document is an authorization form for the use and disclosure of protected health information related to patients of Michael O. LaGrone, M.D., specializing in orthopaedic surgery, particularly spine surgery and pediatric orthopaedics. It outlines the patient's details, the healthcare provider's information, the specific medical records to be disclosed, reasons for the release of information, and includes a section for patient consent and signature.

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2016	4 Satisfied (40 Votes)

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