• Medical Records Release 1

    Records to FMMD
  •  - -

  • To: Medical Records

  • From: Anita Kriplani, MD/FunctionalMedicine.MD
    1245 Wilshire Blvd, Suite 511, North Tower
    Los Angeles, CA 90017
    Release of Records to:
    Anita Kriplani, MD/FunctionalMedicine.MD
    1245 Wilshire Blvd, Suite 511, North Tower
    Los Angeles, CA 90017
    Phone: 213-269-4576
    Fax: 213-269-4577

     

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  • This message is intended only for the use of the individual(s) or entity to which it is addressed, and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible for delivering the message.

  •  - -

  • Authorizes:

  •  {patientName}   {patientDate}   {date} 

  • Authorization of Specific Information to be released:

  • Clear
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