The undersigned health work benefactor herewith authorizes Lab firm and its subsidiaries to transmit patient secure upbeat information (PHI) as definite by HIPAA (Health Insurance movability and Accountability Act of 1996) to the fax number listed below. Additionally, the undersigned condition precaution provider understands that it has deemed such transmission is necessary for the purposes of health anxiety treatment, payment, and/or welfare care operations. The undersigned condition anxiety provider may revoke this permission or change the fax number, provided that the undersigned eudaemonia care provider gives Lab Corp just written notice.
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