Get ucla email consent form

Patient Name DOB MRN EMAIL CONSENT FORM UCLA Healthcare Santa Monica UCLA Medical Center and Orthopedic Hospital Stewart and Lynda Resnick Neuropsychiatric Hospital You and your Health care provider have agreed to correspond using electronic mail e-mail. This form provides guidelines for the intended use of this type of communication and documents your consent. IN A MEDICAL EMERGENCY DO NOT USE E-MAIL* CALL 911....
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