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MED RECORD NO.HILL COUNTRY MEMORIAL HOSPITAL
Post Office Box 830 / Fredericksburg, Texas 78624
The Hill Countries Hospital / hillcountrymemorial. Preauthorization TO RELEASE
PROTECTED HEALTH INFORMATION
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I hereby authorize you is a document giving permission for someone to act on your behalf or access certain information.
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To fill out I hereby authorize you, you must include your name, contact information, the name of the person you are authorizing, the specific permissions granted, and the duration of the authorization.
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The purpose of I hereby authorize you is to legally give someone permission to act on your behalf or access specific information.
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The information reported on I hereby authorize you includes the names of both the authorizer and the authorized party, the specific permissions granted, and the duration of the authorization.
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