AUTHORIZATION FOR USE OR DISCLOSURE OF
PROTECTED HEALTH INFORMATION
Purpose of Disclosure: The reason I am authorizing release is:
Our Services
1 hr 30 min
120 US dollars
1 hr 30 min
120 US dollars
1 hr
120 US dollars
AUTHORIZATION FOR USE OR DISCLOSURE OF
PROTECTED HEALTH INFORMATION
Purpose of Disclosure: The reason I am authorizing release is:
1 hr 30 min
1 hr 30 min
1 hr