Authorization to Release Veterinary Medical Records

(Veterinarian) to release the following Medical Information for the Patient in accordance with laws and regulations applicable to the release of Patient Medical records. (1 to 2 bus. day turnaround)

Records are being requested to establish a full health history for an upcoming appointment with us at Liberty Vet Pets 265 S 20th Street, Philadelphia, PA 19103Fax (888) 458-8587 or [email protected]

For any questions, concerns, or issues; please call (888) 458-8587

Records are being requested for your personal use:

I release the Veterinarian and staff members from any legal responsibility and liability or the release of information to the extent indicated as authorized herein.

Pets12 Or Older For Grooming Pet Hotel Day CareThis release of Veterinary Records is governed by statutory and regulatory provisions, see American Veterinary Medical Association Confidentiality and Patient records summary of provisions via this link: https://www.avma.org/Advocacy/StateandLocal/Pages?sr-confidentiality-patient-records.aspx. Note that State Veterinary Medical Boards have the authority to interpret and enforce provisions of veterinary practice acts. If you have a question about how a particular State Law Provision applies to individual circumstances in that state, please contact your state’s veterinary medical board which can be accessed here: https://www.avma.org/KB/Resources/Reference/Pages/... *