I hereby request that the Sutter Health affiliate provides access to the health information in My Health Online allowable by law, of the patient named below to the following individual. For stepparents, please complete the “Written Authorization for a Stepparent to Access the Medical Record of a Minor Child” form found on this website. Please complete all fields and print legibly to ensure timely processing.
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P.O. Box 255386
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Sacramento, CA 95865-5386
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