Forward Records To Artisan Optics

My personal health information, and complete medical records may be released to the Doctors affiliated with:

ARTISAN OPTICS (please fax the requested information as noted below)

UPTOWN BOISE 7960 W. RIFLEMAN ST., #150 BOISE, IDAHO 83704 Telephone: 208.377.8899 FAX: 208.321.1952

This records release is valid for 1 (one) year from the date of signing. This records request is for the purpose of continuation of care. Artisan Optics is not liable for any fees associated with the release of the requested information. The patient bears that liability, and requests to be notified in advance of any charges for the release of PHI and/or medical records.