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Office Policies - Release of Medical Information and Assignment of Benefits

You authorize Pediatric Health Associates, Ltd. to release any medical information and copies of any medical records necessary to process a related claim and to request payment of benefits directly to Pediatric Health Associates, Ltd. You also authorize Pediatric Health Associates, Ltd. to release your current and former insurance plans and any other physicians, any medical information and copies of medical records requested by those parties for purposed including but not limited to: medical consultations and office visits, hospitalizations, lab/medical testing and insurance chart reviews. Medical information will only be released to parents (or patients who are 18 years of age or older), following State and Federal guidelines. Medical information will not be released to any other parties, unless legal documentations has been provided to Pediatric Health Associates, Ltd.