Matthew Washington

 
 Q sharecare 
 CERTIFICATION OF MEDICAL RECORDS 
 As the Release of Information service provider for: OrthoVirginia - North 
 I certify that to the best of my knowledge that: 
 A. The copy of the MEDICAL records attached to this affidavit is a true copy of the 
 records maintained in the designated record set and described in the subpoena 
 duces tecum, request or authorization. If any records were omitted, they were 
 omitted for the specified reason(s) below: 
 patient name: Matthew Washington DOB: 15/92/03 
 I agree that a digital reproduction of this signed certification be accepted with same 
 authority as the original. 
 I 
 declare(or certify, verify, or state) under the penalty of perjury that the foregoing 
 is true and correct. 
 DATE:19/20/08
 CITY/STATE:Fairfax VA 
 SIGNATURE: 
 PRINTED: Kristy Smart 
 TITLE: Release of Information Service Provider
