Results for Commonwealth C170 Trimmer
|1.||Patient Medical History - Commonwealth Primary CarePhysician/Location: □ Glen Forest □ Ridgefield □ Three Chopt □ Huguenot □
RPC □ Wyndham. □ Sommerville □ VFP □ Commonwealth Extended Care.
Patient Name: ...Tags:Commonwealth Primary Care
|2.||Medical Records Release - Commonwealth Primary CareOF THE ABOVE LISTED PATIENT. UNDERSTAND THAT MAY RESTRICT THE
DISCLOSURE AT ANY TIME. IT IS. UNDERSTOOD THAT THESE RECORDS
CAN INCLUDE ANY AND/OR ALL RECORDS RELATING TO MEDICAL AND/OR
. MENTAL HEALTH CONDITIONS, DRUG/ALCOHOLDIAGNOSIS AND ..Tags:Commonwealth Primary Care
|3.||Medical Records Release - Commonwealth Primary CareI AUTHORIZE COMMONWEALTH PRIMARY CARE TO RELEASE/RECEIVE THE
. CONFIDENTIAL HEALTHCARE RECORDS OF THE ABOVE LISTED PATIENT. I
. UNDERSTAND THAT I MAY RESTRICT THE DISCLOSURE AT ANY TIME. IT IS
. UNDERSTOOD THAT THESE RECORDS CAN INCLUDETags:Commonwealth Primary Care
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