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Collaborative Natural Health Partners, LLC fax number

(866) 603-4163

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Family Medicine

Used for: Authorization to release/receive confidential health information; medical records transfer and care coordination between providers.

Fax destination details

Department
Family Medicine
Purpose
Authorization to release/receive confidential health information; medical records transfer and care coordination between providers.
Form
Authorization To Release/To Receive Confidential Health Information
Address
315 East Center Street, Manchester, CT 06040
Voice phone
860-533-0179

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Form authorizes release/transfer of patient health information to Collaborative Natural Health Partners, LLC. Valid for 90 days from signing unless revoked; may involve charges for records; may require patient consent for certain protected information.

Official form instructions are published as a downloadable file on the organization's website.

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