Request for and Authorization to Release
Medical Records or Health Information
In order to better suit your needs, it is absolutely necessary that we receive copies of clients "Medical Records" and/or other health information. This health information could include: medical history, diagnoses, medication lists, and chart notes. We must have your permission to speak to your health care representatives on your behalf, in order to gather information that relates and pertains to your long term care.
Copyright © Senior Housing Specialists | All Rights Reserved
Phone: 1-866-611-1634 | email@example.com