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Directory Results for Authorization REVOKED on: Verbally by Client in Writing by Client Staff Signature: 702 Sunset Drive, Ontario, Oregon 97914 Telephone: (541) 8899167 Fax: (541) 8897873 AUTHORIZATION TO DISCLOSE, RECEIVE AND USE PROTECTED HEALTH INATION - to Authorization ROI 2013.doc

Authorization REVOKED on: Verbally by Client in Writing by Client Staff Signature: 702 Sunset Drive, Ontario, Oregon 97914 Telephone: (541) 8899167 Fax: (541) 8897873 AUTHORIZATION TO DISCLOSE, RECEIVE AND USE PROTECTED HEALTH INATION -
Authorization ROI (TMS) .docx
Authorization ROI 2013.doc