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FOR REFERRING PHYSICIANS

Physicians, below you will find a series of documents in PDF form. These can be used for requesting files to and from Foothill Cardiology.

Download the form, open the form, fill in the form on your computer, print out and bring to next appointment.

Request for Foothill Cardiology patient medical information to be released to outside sources.

FROM>FC

Click to download the document

Request for patient medical information to be released to Foothill Cardiology.

TO>FC

Click to download the document

AUTHORIZATION FOR RELEASE AND / OR DISCLOSURE OF MEDICAL INFORMATION

Completion of these documents authorizes the disclosure and/or use of individually identifiable health information, asset forth below, consistent with the Confidentiality of Medical Information Act of 1981, Civil Code Section 56 et seq,concerning the privacy of such information.

 

CONNECTIONS

© 2017 Foothill Cardiology/California Heart Medical Group, Inc. All rights reserved.

ARCADIA

Phone: 626.254.0074

289 W. Huntington Drive

Suite 401

Arcadia, CA 91007

COVINA

Phone: 626.915.4700

315 N. Third Ave.
Suite 207

Covina, CA 91723

PASADENA

Phone: 626.793.4139

625 S Fair Oaks Ave
Suite 215
Pasadena CA 91105

Business/Admin:

Phone: 626.793.2885

3452 E Foothill Blvd.
Suite 130

Pasadena, CA 91107