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PATIENT REQUEST FOR AMENDMENT OF HEALTH INFORMATION FORMS (100/CASE)


Our Price: Call for Pricing
Item Number: W-HIP105
THE PATIENT WHO REQUESTS THAT AN AMENDMENT BE MADE TO HIS RECORD WILL BE ASKED TO COMPLETE THIS REQUEST. IT CONTAINS ALL ELEMENTS NECESSARY FOR THE PROVIDER TO MAKE A DECISION TO GRANT OR DENY THE REQUEST. THE FORM IS RETAINED IN THE PATIENT'S MEDICAL RECORD.
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