Authorization for Release of Protected Health Information
|
 |
The following forms are saved as PDF files.
Adobe Acrobat is FREE to download. |
|
After completing the information, be sure to sign the form and return it to the address listed on the top of authorization.
|
| Generic
|
|
|
| Family
Medicine |
|
|
| Internal Medicine |
|
|
| Obstetrics/Gynecology |
|
|
| Surgeons |
|
Community Medical Centers
Urgent Care and Family Medicine |
|
|
| Lexington Hospital Services |
|
|
|
Community Outreach |
|
|
Specialists |
|
|
