which is in the possession of this person or entity, to
We appreciate a reason given for the transfer:
These records include, but are not limited to: personal patient information, medical and dental histories, examination records, radiographs, treatment plans, treatment records, referral and consultation recommendations and reports, and other related materials.
I expressly release from liability the above named person or entity from any and all liability arising from compliance with this request and disclosure of the requested information.
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