ࡱ> Root Entry bDɶ!FileHeaderODocInfo@BBodyText Aɶ Aɶ !"#$&*')%(-./Root Entryp̲ʶ !FileHeaderODocInfo@^BodyText p[ʶp̲ʶ +, !"#$%&'()*+,-./012345679:;<=>?ABCDEFGHIJKLMN^PQRVWXYZ[\]_`abcdfghijklmnopqrstuvwxyz{|}~Scripts / /JScriptVersion TDefaultJScriptS_LinkDocU HwpSummaryInformation.8PrvImage PrvTextDocOptions / /Section0e<><> <REQUEST FOR DISCLOSURE OR REPRODUCTION OF MEDICAL RECORDS> <Patient><Name><Contact Information><Foreign Registration Number><Address> <> <Records are to Be Released to :><Name><Relationship to the Patient><Foreign Registration Number><Contact Information><Address> <> <Scope of the Records Requested & Grounds for the Request><in the Case of Disclosure (for Reading Only)><in the Case of Reproduction (for Photocopying)> < I, as the Patient(or a legal representative of the Patient), hereby request that any and all of my medical records and related information pertaining to my care and treatment should be released to ( MENTIONED ABOVE ) in such manner as stated above, in accordance with Clause 2 of Article 21 of Medical Service Act and Article 13-2 of ENFORCEMENT RULES of the same Act. 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