s3.amazonaws.com · I hereby authorize Louisiana Ear, Nose, Throat & Sinus (LENTS) to release the...

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Transcript of s3.amazonaws.com · I hereby authorize Louisiana Ear, Nose, Throat & Sinus (LENTS) to release the...

Page 1: s3.amazonaws.com · I hereby authorize Louisiana Ear, Nose, Throat & Sinus (LENTS) to release the medical records specified below TO: NAME AND ADDRESS OF PERSON/ORGANIZATION RECEIVING
Page 2: s3.amazonaws.com · I hereby authorize Louisiana Ear, Nose, Throat & Sinus (LENTS) to release the medical records specified below TO: NAME AND ADDRESS OF PERSON/ORGANIZATION RECEIVING
Page 3: s3.amazonaws.com · I hereby authorize Louisiana Ear, Nose, Throat & Sinus (LENTS) to release the medical records specified below TO: NAME AND ADDRESS OF PERSON/ORGANIZATION RECEIVING
Page 4: s3.amazonaws.com · I hereby authorize Louisiana Ear, Nose, Throat & Sinus (LENTS) to release the medical records specified below TO: NAME AND ADDRESS OF PERSON/ORGANIZATION RECEIVING
Page 5: s3.amazonaws.com · I hereby authorize Louisiana Ear, Nose, Throat & Sinus (LENTS) to release the medical records specified below TO: NAME AND ADDRESS OF PERSON/ORGANIZATION RECEIVING
Page 6: s3.amazonaws.com · I hereby authorize Louisiana Ear, Nose, Throat & Sinus (LENTS) to release the medical records specified below TO: NAME AND ADDRESS OF PERSON/ORGANIZATION RECEIVING