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The undersigned health care provider hereby authorizes Lab Corp and its subsidiaries to send patient shielded health info (PHI) as defined by HIPAA (Health Insurance Portability and responsibleness Act of 1996) to the fax number registered below. Additionally, the undersigned wellness care helper understands that it has deemed such communicating is necessary for the purposes of wellness precaution treatment, payment, and/or wellness care operations. The undersigned health predicament provider may fault this authorisation or change the fax number, provided that the undersigned health care benefactor gives Lab Corp reasonable written notice.
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