· 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do...

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Transcript of  · 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do...

Page 1:  · 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do hereby authorize the above practitioner to furnish you, my attorney, with a full
Page 2:  · 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do hereby authorize the above practitioner to furnish you, my attorney, with a full
Page 3:  · 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do hereby authorize the above practitioner to furnish you, my attorney, with a full
Page 4:  · 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do hereby authorize the above practitioner to furnish you, my attorney, with a full
Page 5:  · 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do hereby authorize the above practitioner to furnish you, my attorney, with a full
Page 6:  · 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do hereby authorize the above practitioner to furnish you, my attorney, with a full
Page 7:  · 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do hereby authorize the above practitioner to furnish you, my attorney, with a full
Page 8:  · 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do hereby authorize the above practitioner to furnish you, my attorney, with a full
Page 9:  · 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do hereby authorize the above practitioner to furnish you, my attorney, with a full
Page 10:  · 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do hereby authorize the above practitioner to furnish you, my attorney, with a full
Page 11:  · 2019-06-24 · NEW PORT RICHEY, FL 34654 RE: Health Care Reports and Practitioner's Lien I do hereby authorize the above practitioner to furnish you, my attorney, with a full