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Request Timeline
• • •
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Medical Release
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Medical Receive
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Patient name and DOB
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Received from
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Disclosure
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Received from:Name, Attn:, Phone, Fax.
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Disclosed to:Name, Attn:, Phone, Fax.
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What records being requested?
• • •
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Body of letter
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Signature
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Date
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Fax Results
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