Pittsburgh Pennsylvania Authority for Release of Medical Information

State:
Multi-State
City:
Pittsburgh
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.
Free preview
  • Form preview
  • Form preview

Trusted and secure by over 3 million people of the world’s leading companies

Pittsburgh Pennsylvania Authority for Release of Medical Information