• Medical Records Release to Communicare Therapy Services (Therapy Clinic)

    Fax 678-701-1139
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  • By signing this form, I authorize you to release confidential health information about me, by releasing a copy of my medical records, or a summary or narrative of my protected health information to the facility listed below: Communicare Therapy Services. 


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  • Clear
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  • Parent or Legally Authorized Representative

    In case the subject is beyond the legal age of consent:

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  • Should be Empty: