RELEASE OF INFORMATION PEMBROKE HOSPITAL
199 Oak Street. Pembroke, MA 02359. Tel. (781) 829-7000 Fax: (781) 829-7306. I, _______________________________________________, authorize and request Pembroke Hospital. To receive and release information from or to the person, agency, or facility named below, either verbally or. in writing, specifically information from the medical/psychiatric records obtained in …
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