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Release of information department / Medical record / HIV / HIV/AIDS / Medicine / Health


Bradley University Student Health Center 819 N. Glenwood Ave – Markin Center, Peoria, IL[removed]Telephone: ([removed]Fax: ([removed]AUTHORIZATION FOR RELEASE OF INFORMATION I authorize Bradley Health Center to
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Document Date: 2012-05-16 14:52:42


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City

Peoria / /

Facility

Markin Center / /

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MedicalCondition

developmental disabilities / HIV / drug abuse / /

MedicalTreatment

Immunization / /

Organization

Bradley Health Center / Markin Center / Bradley University Student Health Center / /

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ProvinceOrState

Illinois / /

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