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Vietnamese registration forms · PATIENT AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH...

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Page 1: Vietnamese registration forms · PATIENT AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION TO BETTER HEALTHCARE GROUP By the authorization, I authorize: Name of

Page 2: Vietnamese registration forms · PATIENT AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION TO BETTER HEALTHCARE GROUP By the authorization, I authorize: Name of

Page 3: Vietnamese registration forms · PATIENT AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION TO BETTER HEALTHCARE GROUP By the authorization, I authorize: Name of

Page 4: Vietnamese registration forms · PATIENT AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION TO BETTER HEALTHCARE GROUP By the authorization, I authorize: Name of

Page 5: Vietnamese registration forms · PATIENT AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION TO BETTER HEALTHCARE GROUP By the authorization, I authorize: Name of

Page 6: Vietnamese registration forms · PATIENT AUTHORIZATION FOR USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION TO BETTER HEALTHCARE GROUP By the authorization, I authorize: Name of

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