• Medical Records Request To PHA

  • Authorization Release Of Confidential Medical Information

    I hereby request that my medical records be released to:

    Pediatrics Healthcare Associates

    3701 Eldorado Parkway Suite A

     Mckinney, TX 75070

    Phone: 972-548-7888         Fax: 972-562-1170

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  • As the guardian of the patient(s) listed below, I give permission to release all medical, mental, and social information to the facility listed. I understand that this information is confidential and will only be used for the benefit of the patient. I further understand that this release is valid for one year from date of signing or until I revoke the authorization in writing.

  • Clear
  • 3701 Eldorado Parkway, Suite 100, Mckinney, TX 75070 | P:972-548-7888 | F: 972-562-1170 | www.phamckinney.com
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