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I, Allison Harrington, date of birth 71652 hereby authorize all medical service resources and
healthcare providers to use and/or disclose the protected health information (PHI) described below
to: First Physician's Health Services. The purpose of this release is personal. I hereby authorized
the release of PHI covering the period of 1/51/10/2021. I hereby authorize the release of PHI as
follows: entire health record. This authorization shall be in force and effect until nine (9) months
after my death or January 1, 2023 (date or event) at which time this authorization expires. Allison
Harrington January 14,2021 Signed

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I Allison Harrington date of birth 71652 hereby authorize .pdf

  • 1. I, Allison Harrington, date of birth 71652 hereby authorize all medical service resources and healthcare providers to use and/or disclose the protected health information (PHI) described below to: First Physician's Health Services. The purpose of this release is personal. I hereby authorized the release of PHI covering the period of 1/51/10/2021. I hereby authorize the release of PHI as follows: entire health record. This authorization shall be in force and effect until nine (9) months after my death or January 1, 2023 (date or event) at which time this authorization expires. Allison Harrington January 14,2021 Signed