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The undersigned well-being care provider hereby authorizes Lab Corp and its subsidiaries to send patient stormproof eudaemonia information (PHI) as outlined by HIPAA (Health Insurance Portability and Accountability Act of 1996) to the fax definite quantity enrolled below. Additionally, the undersigned health care bourgeois understands that it has deemed such communication is necessary for the purposes of wellness aid treatment, payment, and/or status aid operations. The undersigned welfare care provider may repeal this authority or change the fax number, provided that the undersigned health care bourgeois gives Lab firm reasonable written notice.


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