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.
Medical Authorization Withdrawal In Cook
Category:
State:
Multi-State
County:
Cook
Control #:
US-00426
Format:
Word;
Rich Text
Instant download
Description
Free preview
