At Speedy Template, You can download Maryland Medical Records Release Form 2 . There are a few ways to find the forms or templates you need. You can choose forms in your state, use search feature to find the related forms. At the end of each page, there is "Download" button for the forms you are looking form if the forms don't display properly on the page, the Word or Excel or PDF files should give you a better reivew of the page.
This form is provided by Specialized Eye Care to authorize the disclosure or release of one person's protected health information.
SPECIALIZED EYE CARE (located in the Village of Cross Keys)
1 Village Square, Suite 190 Baltimore, Maryland 21210 | Phone: 410-435-8881 | Fax: 410-435-8886 | Website:www.specializedeyecare.com
MEDICAL RECORDS RELEASE AUTHORIZATION FORM
PATIENT NAME __________________________________________________________________________