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Pediatricians in Lone Tree, CO at Lone Tree Pediatrics Form
Form will need to be updated annually and any changes must be made in writing. CONSENT TO PERMIT CERTAIN INDIVIDUALS TO ACCOMPANY CHILD REN FOR TREAMENT I hereby authorize the following individual s to accompany my child ren to Lone Tree Pediatrics for the provision of medical services and to view or discuss my child ren s Protected Health Information PHI. Com Website lonetreepediatrics. com PARENT/GUARDIAN PRE-AUTHORIZATION TO PROVIDE MEDICAL CARE TO AN UNACCOMPANIED PATIENT In order to...
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