Henry Ford Medical Records Release Form
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Web send henry ford medical records release form via email, link, or fax. Web download and complete this form to authorize the release of your medical information to a third party or yourself. You can also download it, export it or print it out. Web this authorization is valid only if received by henry ford health system within 60 days.
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Web Send Henry Ford Medical Records Release Form Via Email, Link, Or Fax.
Web please check box(s) below if you want to include medical records for these services: Contact information is available at the top of the form. Web this authorization is valid only if received by henry ford health system within 60 days of the date signed. A valid patient release or authorization, signed by the patient, guardian, or personal.
Web Download And Complete This Form To Authorize The Release Of Your Medical Information To A Third Party Or Yourself.
You can also download it, export it or print it out. Web henry ford health system medical records department.