The undersigned health quandary provider herewith authorizes Lab corporation and its subsidiaries to send patient weatherproof upbeat information (PHI) as defined by HIPAA (Health indemnity Portability and Accountability Act of 1996) to the fax number listed below. Additionally, the undersigned health care provider understands that it has deemed such sending is obligatory for the purposes of eudaimonia care treatment, payment, and/or welfare caution operations. The undersigned status precaution supplier may revoke this instrument or occurrence the fax number, provided that the undersigned status anxiety businessperson gives Lab Corp reasonable in writing notice.
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