Chandler Arizona Autoridad para la divulgación de información médica - Authority for Release of Medical Information
Category:
State:
Multi-State
City:
Chandler
Control #:
US-00426
Format:
Word
Instant download
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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