FLORIDA NEUROVASCULAR INSTITUTE

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    Consent to Release Medical Information

    I AUTHORIZE YOU TO RELEASE MY CONFIDENTIAL MEDICAL INFORMATION TO:

    Erfan A. Albakri, M.D. FAHA Florida Neurovascular Institute 5 Tampa General Cir. Suite 200 Tampa, FL 33606 Phone (813) 250-9101 Fax (813) 844-4952 ► Physician's Office Reports ► Hospital Medical Records ► Radiology Reports ► Laboratory Reports
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