Rx Medical Release Form

RX Medical Release Form

Please download and print the Right to Access and Consent for Release of Protected Health Information (PHI) form.

Medical Release Formfill out the form and mail or fax it to:

Your local Discount Drug Mart Store.
find your store here

– or –

Discount Drug Mart’s Corporate Office.
Attn: Pharmacy Operations/Medical Records
211 Commerce Drive
Medina, OH 44256
Fax: 330-764-4857

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