Authorization for Release of Medical Information


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Signature Certificate
Document name: Authorization for Release of Medical Information
lock iconUnique Document ID: b8c1d2d4e04dfb7f2d06650a2f0437c3cb577604
Timestamp Audit
July 28, 2022 2:28 am ESTAuthorization for Release of Medical Information Uploaded by TruReleaf MD LLC - records@trureleafmd.com IP 35.141.6.16
July 28, 2022 2:29 am ESTTruReleafMD Records - records@mmtclinics.com added by TruReleaf MD LLC - records@trureleafmd.com as a CC'd Recipient Ip: 35.141.6.16
July 29, 2022 2:54 am ESTTruReleafMD Records - records@mmtclinics.com added by TruReleaf MD LLC - records@trureleafmd.com as a CC'd Recipient Ip: 35.141.6.16
July 29, 2022 3:02 am ESTTruReleafMD Records - records@mmtclinics.com added by TruReleaf MD LLC - records@trureleafmd.com as a CC'd Recipient Ip: 35.141.6.16