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

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

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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

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