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Medical Information Authorization Without In Santa Clara

Category:
Releases and Waivers - Medical
State:
Multi-State
County:
Santa Clara
Control #:
US-00426
Format:
Word; 
Rich Text
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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.
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Medical Information Authorization Without In Santa Clara
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