Authorization for Use or Disclosure of Medical Information


For our patients convience the District's 'Authorization for Use or Disclosure of Medical Information' form is available for printing out and completion. It can then be faxed back to the District at the fax number on page two of the form.

Authorization for Use or Disclosure of Medical Information form

Contact Us

John C. Fremont
Healthcare District

Attn:
Matthew Matthiessen, CFO, Interim CEO
P.O. Box 216
Mariposa, CA 95338-0216
209-966-3631   ext. 5101
209-966-3776   Fax
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