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WEB- Baptist . Health . H·229 AUTHORIZATION FOR BAPTIST HEAL TH TO DISCLOSE INFORMATION TO OTHERS . 1111111111111H~~1111111111 . Patient Name _____ …

Actived: 9 days ago

URL: https://mychartpoc.baptist-health.org/mychart/en-US/docs/H229_Medical_Records_Request.pdf

AUTHORIZATION TO ACCESS MYCHART PROTAL FOR …

WEBAUTHORIZATION TO ACCESS MYCHART PROTAL FOR OTHERS INVOLVED IN MY CARE Patient Name_____ I hereby request access to MyChart Portal for the following …

Category:  Health Go Health

Request for Medical Records

WEBRequest for Medical Records Patient Name: _____ Date of Birth:_____ Phone Number_____ Last Four Digits of Social Security Number:_____

Category:  Medical Go Health

FINANCIAL ASSISTANCE GUIDELINES

WEBIf you believe you may be eligible for financial assistance, please ask your Admissions Representative for an application. e application can also be requested: By phone: …

Category:  Health Go Health

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