Medical Records Release Request

Medical information

What medical information may be released?

All information INCLUDING substance abuse, mental health, or HIV-AIDS information All information EXCEPT one or more of the following: substance abuse, mental health, or HIV-AIDS information Only specific medical information

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Medical information

What medical information may be released?

Which medical information should NOT be released?

What other information, should NOT be released?

What specific medical information may be released?

Authorization expire

When will this Authorization expire?