Tallahassee, FL 32308 Fax (844) 261-6839 Tallahassee Orthopedic Clinic @ B ainbridge 603 S. Wheat Avenue, Suite 800 (229) 246-3608 Bainbridge, GA 39819 Fax (844) 261-6838 Tallahassee Orthopedic Clinic @ Marianna 3051 6th Street (850) 526-3236 Marianna, FL 32446 Fax (844) 261-6844 Tallahassee Orthopedic Clinic @ Perry 333 N. Byron Butler Pkwy.
toc @ bainbridge phone: 229.246.3608 fax: 844.261.6838 3334 capital medical blvd, ste 400 | 1401 centerville rd, ste 710 | 1981 capital circle ne | 2160 capital circle ne, ste 200 phone: 850.877.8174 fax: 844.261.6839 consultation request
TALLAHASSEE ORTHOPEDIC CLINIC ("TOC") AUTHORIZATION TO RELEASE INFORMATION Patient's Name: (Last) (First) (Initial) (Date of Birth) (Social Security Number) Address: (Street) (City) (State) (Zip) Home Telephone Work Telephone Email I authorize TOC (the "Releaser") to disclose and release Patient's Protected Health Information ("PHI") from …
TO TALLAHASSEE ORTHOPEDIC CLINIC ("TOC") 3334 Capital Medical Blvd. Tallahassee, FL 32309 | Fax# 844-261-6839 Patient's Name: (Last) (First) (Initial) (Date of Birth) ... I authorize TOC, the Releaser, to disclose and release the specific PHI, as indicated, to the Releasee, as listed, for the specific use(s) and purpose(s) listed.
TOC delivers cutting-edge care in the fields of general orthopedics, sports medicine, hand and wrist, foot and ankle, shoulder and elbow, joint replacement, spine, neck and back, trauma, primary care sports medicine and sports-related concussion.
Tallahassee Orthopedic Clinic Author: Tallahassee Orthopedic Created Date: 5/12/2024 11:44:21 PM ...
Tallahassee Orthopedic Clinic . Author: Jenni Puhr Created Date: 5/13/2024 2:49:08 AM ...
Tallahassee Orthopedic Clinic Author: Tallahassee Orthopedic Created Date: 5/13/2024 12:31:57 AM ...
Tallahassee Orthopedic Clinic, P.A., 3334 Capital Medical Boulevard, Suite 400, Tallahassee, Florida 32308, wholly owns the Magnetic Resonance Imaging system (MRI) for which you may be referred. You are not required to obtain items or services but may obtain items or services from the provider or supplier of your choice.
TOC delivers cutting -edge care in the fields of general orthopedics, sports medicine, hand and wrist, foot and ankle, shoulder and elbow, joint replacement, spine, neck and back, trauma, primary care sports medicine and sports-related concussion.