Central Maine Medical Center Records Departmentx Raw Image867dfda9c89596eb8699ae7f4523cd1a4388b4625a25cca9e46c66310dffac39x Raw Image55a19ae5bd8268df76b0f47c3df2f548896eef51b9167a89c0c047bc70c2fa21x Raw Imagec63f2d8eeccb20b0618172f8782c6601e1e7db79004a280213aa4cd40a89a0f0x Raw Image6d9805e54363ce9ef3be6a78b9caaeb8737e625850f358e0ddf3cbbd989c0b75x Raw Imagec63f2d8eeccb20b0618172f8782c6601e1e7db79004a280213aa4cd40a89a0f0x Raw Image6d9805e54363ce9ef3be6a78b9caaeb8737e625850f358e0ddf3cbbd989c0b75

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AUTHORIZATION: I give permission to use and release to Recipient Name: HR Solution Center | MaineHealth | Employees. Medical Records Request | Ascension.

Central Maine Medical Center Records Departmentx Raw Image867dfda9c89596eb8699ae7f4523cd1a4388b4625a25cca9e46c66310dffac39x Raw Image55a19ae5bd8268df76b0f47c3df2f548896eef51b9167a89c0c047bc70c2fa21x Raw Imagec63f2d8eeccb20b0618172f8782c6601e1e7db79004a280213aa4cd40a89a0f0x Raw Image6d9805e54363ce9ef3be6a78b9caaeb8737e625850f358e0ddf3cbbd989c0b75x Raw Imagec63f2d8eeccb20b0618172f8782c6601e1e7db79004a280213aa4cd40a89a0f0x Raw Image6d9805e54363ce9ef3be6a78b9caaeb8737e625850f358e0ddf3cbbd989c0b75

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AUTHORIZATION: I give permission to use and release to Recipient Name:

MEDICAL RECORDS RELEASE Pa�ent Name: DOB: I authorize the following custodian/en�ty to release the requested Medical Recor

Central Maine Medical Center Records Departmentx Raw Image867dfda9c89596eb8699ae7f4523cd1a4388b4625a25cca9e46c66310dffac39x Raw Image55a19ae5bd8268df76b0f47c3df2f548896eef51b9167a89c0c047bc70c2fa21x Raw Imagec63f2d8eeccb20b0618172f8782c6601e1e7db79004a280213aa4cd40a89a0f0x Raw Image6d9805e54363ce9ef3be6a78b9caaeb8737e625850f358e0ddf3cbbd989c0b75x Raw Imagec63f2d8eeccb20b0618172f8782c6601e1e7db79004a280213aa4cd40a89a0f0x Raw Image6d9805e54363ce9ef3be6a78b9caaeb8737e625850f358e0ddf3cbbd989c0b75

Gallery for Central Maine Medical Center Records Departmentx Raw Image867dfda9c89596eb8699ae7f4523cd1a4388b4625a25cca9e46c66310dffac39x Raw Image55a19ae5bd8268df76b0f47c3df2f548896eef51b9167a89c0c047bc70c2fa21x Raw Imagec63f2d8eeccb20b0618172f8782c6601e1e7db79004a280213aa4cd40a89a0f0x Raw Image6d9805e54363ce9ef3be6a78b9caaeb8737e625850f358e0ddf3cbbd989c0b75x Raw Imagec63f2d8eeccb20b0618172f8782c6601e1e7db79004a280213aa4cd40a89a0f0x Raw Image6d9805e54363ce9ef3be6a78b9caaeb8737e625850f358e0ddf3cbbd989c0b75