Medical Authorization Cover Letters

To, Dr. Michael Black

Reference:
Patient Name: Mr. Joseph Bicman

You are hereby authorized and intended for to provide to Martin Lee 214,Maerk Street, California. Copies of any therapeutic remarks and medical report organized by you concerning to the above patient.

You are asked for not to release any other information to any other people without my write down authority to do so.

Patient name:Mr. Joseph Bicman

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