Banner University Medical Center Tucson Medical Records Fax Numberx Raw Image27138fe73526fa539f2cb1a7e3a641f998fe9df062c810fa00b133c6cabcffd0x Raw Imagee5ca965fe0819c6f86db72a9876c40f24b9e90042c16b4825892ec1430264f81x Raw Imagee5ca965fe0819c6f86db72a9876c40f24b9e90042c16b4825892ec1430264f81
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Banner University Medical Center Tucson Medical Records Fax Numberx Raw Image27138fe73526fa539f2cb1a7e3a641f998fe9df062c810fa00b133c6cabcffd0x Raw Imagee5ca965fe0819c6f86db72a9876c40f24b9e90042c16b4825892ec1430264f81x Raw Imagee5ca965fe0819c6f86db72a9876c40f24b9e90042c16b4825892ec1430264f81
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MEDICAL RECORDS RELEASE Pa�ent Name: DOB: I authorize the following custodian/en�ty to release the requested Medical Recor
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University Central PO Terms and Conditions - 09/2021 Revisions (00400471).DOCX