The undersigned health quandary provider herewith authorizes Lab Corp and its subsidiaries to send away patient covert health information (PHI) as defined by HIPAA (Health Insurance movableness and Accountability Act of 1996) to the fax number catalogued below. Additionally, the undersigned health concern provider understands that it has deemed specified transmitting is necessary for the purposes of welfare judiciousness treatment, payment, and/or welfare care operations. The undersigned well-being concern provider may annul this legal document or change the fax number, provided that the undersigned eudaimonia judiciousness provider gives Lab firm level-headed printed notice.
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