Records Release Form | Premier Pediatrics

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325 W. 8th Street, DeRidder, LA 70634

Tel: 337-221-3075

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Record Relase

Updated MEDICAL RECORD REQUEST 5-25-2021

Record

Release

Updated Authorized Medical Care 5-25-202

Permission to bring

in patient

© 2018 Premier Pediatrics of Louisiana

325 W. 8th Street, DeRidder, LA 70634

Tel: 337-221-3075

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