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Release of Responsibility for Discharge - 2-part

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$15.90
QuantityPrice
1 – 4$15.90
5 – 9$14.15
10 – 14$12.00
15 +$9.80
SKU: 3022R
$15.90
This form contains information to release your facility from responsibility for a patient if he/she discharges themself from your facility against a physicians and facility administrators advice.

Download a sample today!
Size:  8 1/2" x 5 1/2"
 
Paper/Print:  White paper, blue ink 

Packaging:  100 per pad

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