![Medicaid / Medical record / Health / Medicine / Technology / Fax / Office equipment Medicaid / Medical record / Health / Medicine / Technology / Fax / Office equipment](https://www.pdfsearch.io/img/00169297e5db1207e23c758380f2bb4f.jpg) Date: 2009-07-29 11:58:54Medicaid Medical record Health Medicine Technology Fax Office equipment | | MEDICAL RECORDS RELEASE FORM To further insure compliance with the “Health Insurance Portability Act of 1996”, River Radiology requests your written authorization to release health care information to outside health
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