At Speedy Template, You can download North Carolina 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 to authorize the disclosure or release of one person's protected health information.
Metro Internal Medicine P.A.
Facsimile Transmittal Sheet
Dr Kenneth A. Holt, MD
3320 Executive Dr
Bldg E, Suite 222
Raleigh, NC 27609
Tel: 919.877.1100 Fax: 919.877.8118
AUTHORIZATION TO RELEASE MEDICAL RECORDS AND PATIENT INFORMATION