I hereby request that a copy of his/her medical record(s) including immunization records, growth curves, relevant consultation notes, laboratory results, and progress notes to be forwarded to the following medical practice:
JOANNA BARBARA LIS, M.D.
970 41st STREET, SUITE M1
Brooklyn, N.Y. 11219
Tel. (718) 438-1322
Fax. (718) 438-2295
Thank You for your kind and timely consideration to this matter.
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