Release Records to Brevard ENT
Brevard Ear, Nose and Throat Center
1099 Florida Avenue
Rockledge, FL 32955
(P) 321-632-6900
(F) 321-639-7222
HIPAA Privacy Authorization Form
** Authorization for Use or Disclosure of Protected Health Information
(Required by the Health Insurance Portability and Accountability Act, 45 C.F.R.)