Free Authorization Letter 30
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19200 C, Raven Street
690, Hawks Bay
Mobile, AB – 88888
Sep 20, 2014
Dr. Melissa Hartman
St. Patricks Hospital
333, Fornsworth Road
Mobile, AB - 88888
Sub: Release of Medical Records for Anabelle Lee
Dear Dr. Melissa,
It is humbly requested that you release my medical records and related
information pertaining to my ACL treatment, which I underwent under your
supervision from Aug 12, 2014 to Sep 13, 2014, to Dr. Joseph Smith.
These records will assist in my subsequent medical care. Kindly mail my
medical records to:
Dr. Joseph Smith
Mary Hospital
1555, Lake View Boulevard
Mobile, AB - 88888
Thanking you,