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Huntsville Pediatric Associates Request for Medical Records (This form applies only to the release and disclosure of information. It is not consent for treatment or intended for any other purposes.)
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Document Date: 2014-10-19 17:28:54
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File Size: 26,00 KB
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Company
Huntsville Pediatric Associates LLC /
/
Facility
Memorial Parkway /
/
Person
M.D. Michael Klemm /
M.D. Bryan Laue /
M.D. Brian Patz /
M.D. Timothy Stewart /
Mo Day /
M.D. Sarah Pettigrew /
Rebecca Cochran /
M.D. Katie Gunter /
D. Kevin S. Ellis /
/
Position
Privacy Officer /
physician /
Circle Authorized Physician /
/
ProvinceOrState
Alabama /
/
Technology
X-Ray /
/
Huntsville Pediatric Associates Request for Medical Records (This form applies only to the release and disclosure of information. It is not consent for treatment or intended for any other purposes.)