M.D. GLOBAL, LLC
Medical Records Release Form
Phone: (303) 931-2348   |   Fax: (888) 817-2326   |   familyservices@mdglobal-llc.com
Hereby authorize the release of all of the decedent's medical information such as hospital/physician records and autopsy reports to M.D. Global, Llc and its affiliates to determine their suitability for non-transplant medical donation.
Authorized Signature *
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