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Consent to Use and Disclose Your Health Information

WebShawna S. Brent, MD 20 Erford Road Suite 101 Lemoyne, PA 17043 Phone: (717) 730-8555 Fax: (717) 730-4566 www.shawnabrentmd.com Consent to Use and Disclose …

Actived: 4 days ago

URL: https://www.shawnabrentmd.com/content/uploads/2016/11/npp_consent_form.pdf

ADULT HISTORY FORM

WebADULT HISTORY FORM Your answers on this form will help your provider understand your medical concerns and conditions better. Best estimates are fine if you

Category:  Medical Go Health

Request/Authorization to Release Confidential Records and …

WebRequest/Authorization to Release Confidential Records and Information I hereby authorize: Person or facility: _____ Address: _____ Phone: _____

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Childhood Developmental History Form

WebActivity Level- How active has your child been from an early age? Distractibility- How well was your child able to maintain focus or concentrate on tasks? Adaptability- How well …

Category:  Health Go Health

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