Orchard Medical Center, S.C.
I request and authorize Orchard Medical Center, S.C. to
healthcare information on the patient names above to:
ALL Healthcare Information
I understand by signing below I have the right to inspect or copy the records that are being released. I agree to sign this authorization and understand I will be given a copy once I have signed. I also understand I will need to submit a written letter of cancellation to the Medical Records Department if I choose to cancel this authorization.
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