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AUTHORIZATION FOR THE USE OR DISCLOSURE OF HEALTH INFORMATION Paperboys Date: FaxEmailMailPick Up at:OR Date Needed by: Black Hills Surgical Hospital Black Hills Imaging Center Lombardy Business Office
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Pick up at refers to the location where goods or items are to be picked up.
The person or entity responsible for arranging the pick up of goods is required to file pick up at.
Pick up at can be filled out by providing the specific location where the goods are to be picked up from.
The purpose of pick up at is to ensure that the correct location is identified for the pick up of goods.
Information such as the address, contact person, and pick up date and time must be reported on pick up at.
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