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Medical Authorization Form For Pets In Contra Costa - Authority for Release of Medical Information

Category:
Comunicados - Médico - Arizona
State:
Multi-State
County:
Contra Costa
Control #:
US-00426
Format:
Word
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Description

Patient authorizes the physicians, medical attendants, and the hospital to furnish full and complete medical information to the specified attorney at law, or to any representative or investigator from his/her firm. The form also provides that all prior authorization is cancelled. Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.
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Medical Authorization Form For Pets In Contra Costa
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