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  • Authorization Letter For Medical Records498

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    Michelle Calleja Padit
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    Anabelle Lee authorizes Dr. Melissa Hartman to release her medical records from August 12, 2014 to September 13, 2014 regarding her ACL treatment to Dr. Joseph Smith at Mary Hospital to assist with her subsequent medical care. The records should be mailed to Dr. Smith at Mary Hospital.

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    Anabelle Lee authorizes Dr. Melissa Hartman to release her medical records from August 12, 2014 to September 13, 2014 regarding her ACL treatment to Dr. Joseph Smith at Mary Hospital to assist with her subsequent medical care. The records should be mailed to Dr. Smith at Mary Hospital.

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    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
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    27 views1 page

    Authorization Letter For Medical Records498

    Uploaded by

    Michelle Calleja Padit
    Anabelle Lee authorizes Dr. Melissa Hartman to release her medical records from August 12, 2014 to September 13, 2014 regarding her ACL treatment to Dr. Joseph Smith at Mary Hospital to assist with her subsequent medical care. The records should be mailed to Dr. Smith at Mary Hospital.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
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    Authorization Letter for Medical Records

    Anabelle Lee
    19200 C, Raven Street
    690, Hawks Bay
    Mobile, AB – 88888

    Sep 20, 2014

    Dr. Melissa Hartman


    St. Patricks Hospital
    333, Fornsworth Road
    Mobile, AB - 88888

    Sub: Release of Medical Records for Anabelle Lee

    Dear Dr. Melissa,

    It is humbly requested that you release my medical records and related


    information pertaining to my ACL treatment, which I underwent under your
    supervision from Aug 12, 2014 to Sep 13, 2014, to Dr. Joseph Smith.
    These records will assist in my subsequent medical care. Kindly mail my
    medical records to:

    Dr. Joseph Smith


    Mary Hospital
    1555, Lake View Boulevard
    Mobile, AB - 88888

    Thanking you,

    Sincerely,
    A. Lee
    (Signature)
    Anabelle Lee

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