Chandler Arizona Authority for Release of Medical Information

State:
Multi-State
City:
Chandler
Control #:
US-00426
Format:
Word; 
Rich Text
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.
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Chandler Arizona Authority for Release of Medical Information