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Release of Information Form

Effective August 1, 2024, all FMLA and Disability forms will incur a fee of $25.00 for the first five pages. To ensure compliance, no form will be completed without a dated signature from the patient along with a release of information (HIPAA Authorization for use or Disclosure of health information) form. According to our practice policy, form completion may take up to 14 days. If expedited processing is required, an additional fee of $25.00 will apply.

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