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The undersigned health anxiety bourgeois hereby authorizes Lab Corp and its subsidiaries to post patient protected well-being information (PHI) as circumscribed by HIPAA (Health insurance policy Portability and responsibility Act of 1996) to the fax number listed below. Additionally, the undersigned health judiciousness supplier understands that it has deemed such transmission is necessary for the purposes of status care treatment, payment, and/or upbeat care operations. The undersigned condition care businessperson may reverse this authorization or happening the fax number, provided that the undersigned health care businessperson gives Lab house sound graphical notice.

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