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To Print a:

 

RIGHT TO ACCESS AND CONSENT FOR RELEASE OF

PROTECTED HEALTH INFORMATION (PHI) FORM

 

 

Please fill out the form and mail or Fax it to your local

Discount Drug Mart Store (Find your local Store Info)

Or

DDM Corporate Office

211 Commerce Drive

Medina, Ohio 44256

Attn: Pharmacy Operations/Medical Records

 

Fax: 330-764-4857