This will include personally identifiable, protected.

I, ______hereby voluntarily authorize.

Webto request release of medical information please complete and sign this form.

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Webadventhealth is a personalized healthcare app.

Webplease contact the health information management (him) department for your facility by calling the number listed under records request forms and contact information or by.

Webauthorization to release medical information * indicates a required field.

Webwe'll email you a confirmation of your request when you're finished.

Completion of this document authorizes the disclosure and use of health information.

Please email me a copy of my completed request form.

Webwe'll email you a confirmation of your request when you're finished.

Completion of this document authorizes the disclosure and use of health information.

Please email me a copy of my completed request form.

Webyou'll have direct access to your medical records including lab results, medical images, surgeries, physician notes and more.

Webfor adventist health locations, there are three ways to request your medical records.

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