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  • US Legal Forms
  • Authorization for Release of Information and Medical Payment Benefits...

Authorization for Release of Information and Medical Payment Benefits for a Motor Vehicle Accident Patient

Category:
Consents and Permissions - Releases
State:
Multi-State
Control #:
US-70681NMS
Format:
Word; 
Rich Text
Instant download
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Description

Patient authorization to release any information concerning medical treatment and/or payments for medical treatment received as a result of a motor vehicle accident.

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Authorization for Release of Information and Medical Payment Benefits for a Motor Vehicle Accident Patient
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