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Updated: 5/23/08

NCI Best Case Series Program
NCI Best Case Series Criteria for Optimal Case Studies
Compiling an NCI Best Case Submission
  Sample Medical Records Release Authorization
  Case Summary Format
  Sample Narrative Case Summary
  Best Case Series Program Submission Packet
Frequently Asked Questions about the NCI Best Case Series Program
NCI Best Case Series Highlights
References

Sample Medical Records Release Authorization

TO: _____________________________________

ADDRESS: _________________________________

I hereby authorize you to release my medical records, including operative reports, radiology reports and film copies, pathology reports and slides, and discharge summaries to:

Your name, address, & affiliation
Phone number
Fax number

Print Name of Patient: ______________________________________
 
Patient's Complete Current Address: ______________________________________
 
Signature of Patient: ______________________________________
 
Patient Date of Birth: ______________________________________
 
Date: ______________________________________