Return this completed and signed agreement to HoagMedicalRecords@hoag.org.Phi Disclosure Agreement • December 17th, 2021 • California
Contract Type FiledDecember 17th, 2021 JurisdictionIf you have any questions regarding this form, please contact Health Information Management Services at (949) 764- 8326, Option 5 or HoagMedicalRecords@hoag.org.