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Patient Access Form

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Consent for Patient Portal Access at Northeastern Vermont Regional Hospital

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PATIENT ACCESS

PROXY ACCESS

ACCESS TO MINORS MEDICAL INFORMATION

Relation to Patient (Required)

MINOR ACCESS TO MEDICAL INFORMATION

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Northeastern Vermont Regional Hospital

PO Box 905
1315 Hospital Drive
St. Johnsbury, Vermont 05819

802-748-8141  |  TTY/TTD, Dial 711

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