Sidney H. Levine, MD — North County Orthopedic Medical Group
Patients

Consent to Release Medical Information.

HIPAA authorization to release records to or from Dr. Sidney H. Levine. Bilingual, e-signed, and delivered as a signed PDF.

Call (858) 457-4040All forms

North County Orthopedic Medical Group, Inc.

Consent to Release Medical Information

HIPAA authorization for release of records to or from Sidney H. Levine, MD.

Sidney H. Levine, MD

(858) 457-4040 office · (858) 457-4936 fax

8929 University Center Ln, Ste 100, San Diego, CA 92122-1007

slevine@northcountyomg.com · northcountyomg.com

  1. 1Patient
  2. 2Records & Release
  3. 3Review & Sign

Patient information

You may provide this at the office instead. If entered, it will be masked in the generated PDF (***-**-####).

Do not include sensitive medical information beyond what's asked. For medical emergencies, call 911. No information is stored on your device. Submissions are transmitted securely to our intake system.

Se habla español · Workers' Comp & Longshore accepted · Most major insurance plans

Call (858) 457-4040