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(616)-414-4694 ken@caradigmadvocacy.com

HIPAA Records Release Form

HIPAA Records Release Form

  • I HEREBY GRANT AND AUTHORIZE Ken Kwapiszewski R.Ph. OF Caradigm Patient Advocacy, LLC ACCESS TO ANY MEDICAL RECORDS, REPORTS, CORRESPONDENCE, INSURANCE INFORMATION, AND BILLING INFORMATION AS REQUESTED
  • I authorize Caradigm Patient Advocacy LLC to correspond through any medium with you regarding the above. Should you have any questions, please call Caradigm Patient Advocacy.

    Please address mailed correspondence to:
    Ken Kwapiszewski, R.Ph.
    Caradigm Patient Advocacy, LLC
    17525 N Fruitport Rd. Spring Lake MI 49456

    Other authorized contact information:
    Phone: 616-414-4694
    Email: ken@caradigmadvocacy.com

    Please accept a Photostat copy of this authorization with the same authority as the original.

  • Please type your full name as signature.
  • This field is for validation purposes and should be left unchanged.