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Thomas K. Dothan, PC 2500 82nd PLACE, URBANDALE, IA 50322 15152701344 AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION Patients Name Birthdate / / Address I authorize the following parties 1) Thomas
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Wadle and Associates P is a tax form used by partnerships to report their income, deductions, credits, and other relevant tax information to the IRS.
All partnerships are required to file Wadle and Associates P.
Wadle and Associates P is typically filled out by the partnership's tax preparer or accountant using the information provided by the partnership.
The purpose of Wadle and Associates P is to report the financial activity of the partnership to the IRS for tax purposes.
Wadle and Associates P requires information such as income, deductions, credits, and other financial data related to the partnership.
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Iowa Koithan REDISCLOSURE X-Ray EKG Birthdate 82nd URBANDALE revocation authorizes initialed applicable IA prohibits revoke disclosed ch specify penalties disclosure PROHIBITION revoked Consultation Summary disclose requirements

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