AUTHORIZATION TO RELEASE MEDICAL RECORDS

I request and authorize to release medical records on the patient name above to Pulmonary Practice Associates.

1075 Town Center Drive
Orange City, FL 32763
Fax (386) 917 – 0335

749 Stirling Center Place
Lake Mary, FL 32746
Fax (407) 321 – 0388

This request and authorization applies to (check all that apply):

Pulmonary Function Test(s)Consultation(s)Last office noteRadiology Report(s)Pet ScanChest CTChest X-rayEchocardiogram(s)Laboratory(s)Sleep Study(s)Cardiac Catherization (RHC + LHC)Other

THIS AUTHORIZATION EXPIRES AFTER ONE YEAR FROM THE DATE OF THE PATIENT OR REPRESENTATIVE SIGNATURE

ABOUT US

When it comes to breathing disorders, our physicians and staff at Pulmonary Practice Associates understand how important it is for you to choose a qualified physician who will provide the best care possible to get you back to living a healthy and comfortable life.


1075 Town Center Dr, Orange City, FL 32763
Phone Number: (386) 917-0333
Fax Number: (386) 917-0335

749 Stirling Center Place, Lake Mary, FL 32746
Phone Number: (407) 321-8230
Fax Number: (407) 321-0388

8400 Red Bug Lake Road, Suite 2010, Oviedo, FL, 32765
Phone Number: (407) 321-8230
Fax Number: (407) 321-0388

NEWSLETTER

Signup to receive latest news & offers.

© 2018 Pulmonary Practice Associates - All Rights Reserved.