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Records Release

Releasing My Jackson Siegelbaum Gastroenterology and/or West Shore Endoscopy Center Medical Records TO Another Provider / Healthcare Team

Please complete the form below to authorize Jackson Siegelbaum Gastroenterology and/or West Shore Endoscopy Center to release your medical records to your provider or healthcare team.

If you cannot view the form below, you may click here to access our HIPAA compliant Authorization for Use and Disclosure of Medical Information form.

 

 

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