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March 11, 2010
ZZZ Hospital
Alabama Street

To Whom It May Concern:

I, Wendy White, hereby authorize ABC Hospital to release to Michelle Henderson, my personal records, and as well as my laboratory information that has connection with my previous hospitalization.

I will use the medical records to assists the hospital and the medical doctors to diagnose my health problem. I am hoping for a fast response with regards to this request.

Respectfully,
(Signed)
Wendy White

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