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Records Transfer Authorization from Dignity Health


      1. Click on the link to Records Release Form above.

      2. Print the form.

      3. Fill out a separate form for every patient.

      4. Have another person sign the bottom of the form
          as a witness.

      5. Fax or Mail the form as soons as possible to:

          William F. Baker, Jr., M.D. & Associates
          3008 Sillect Avenue, Suite 240
          Bakersfield, CA 93308
          Phone: 661-616-9300
          Fax: 661-616-9303

      6. Thank you, that's all you have to do. We'll finish the process.


© William F. Baker, Jr., M.D. & Associates 2014