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Health / Buffalo Hospital / Allina Hospitals & Clinics / United Hospital / Medical record / Health informatics / Minneapolis / Medical informatics / Medicine / Minnesota


ALLINA HOSPITALS & CLINICS AUTHORIZATION TO RELEASE AND DISCLOSE PATIENT INFORMATION PATIENT INFORMATION NAME: ______________________________________________________ DATE OF BIRTH: ______________________ Address: _______
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Document Date: 2013-08-11 22:49:38

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File Size: 165,71 KB

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City

Minneapolis / St. Paul / Buffalo / Shoreview / /

Facility

Aspen Bandana Square / United Hospital / Buffalo Hospital / Quello Lakeville Clinic / Allina hospital / /

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MedicalCondition

injury / Immunization/allergy / illness / /

MedicalTreatment

Immunization / immunizations / /

Organization

Allina hospital / Receiving Party / Buffalo Hospital / Allina Corporate Office in Minneapolis / Date Authority / United Hospital / /

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Position

Immunization/allergy record Chemical dependency/ Operative / /

ProvinceOrState

Minnesota / /

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