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Directory Results for I hereby authorize Justifacts Credential Verification, Inc, an Agent for the Tanana Chiefs Conference to ascertain information regarding my to I HEREBY AUTHORIZE MY Attending Physician and/or hospital to release

I hereby authorize Justifacts Credential Verification, Inc, an Agent for the Tanana Chiefs Conference to ascertain information regarding my
I HEREBY AUTHORIZE KANSAS HEALTH INFORMATION NETWORK
I hereby authorize KCTCS to deduct any and all indebtedness that I may have at the Bookstore from any type of financial assistance I might receive - madisonville kctcs
I hereby authorize Kendall Urology Associates to use and/or disclose my health information which specifically identifies me or which can reasonable
I hereby authorize Kent Companies, Inc
I hereby authorize KidMed to transfer, release or obtain information on:
I hereby authorize Kids We Love Childcare or Sally Montaseri, my child\'s care provider, to
I hereby authorize Kinexus CPAs & Advisors to initiate a monthly debit from the account specified below to pay the monthly
I hereby authorize Kingston City School District, hereinafter called COMPANY; to
I hereby authorize Kingston General and Hotel Dieu Hospitals to release information to
I hereby authorize Kingwood Skin Essentials or any delegated associates, to perform pigmented
I hereby authorize KIT CARSON ELECTRIC COOPERATIVE, INC to charge my monthly electrical bill against
I hereby authorize KLA-Tencor Corporation to deposit each of my paychecks to the institution(s) indicated below
I hereby authorize KnightMasden, APAC to initiate a monthly debit from the account specified below to pay the
I hereby authorize Knox County Health Department to request / release (circle one) Protected Health Information
I hereby authorize Kogi Group Corporation of Los Angeles to charge my credit card as specified below
I hereby authorize Kogi Restaurant Group, LLC of Los Angeles to charge my credit card as specified below
I hereby authorize KONIAG INCORPORATED to initiate credit entries to my bank account and to initiate, if
I hereby authorize Kudzu Staffing, Inc
I hereby authorize Kumho Tire USA, Inc
I hereby authorize La Hacienda Treatment Center to release my ...
I hereby authorize Lake Forest College to initiate direct deposit for my payroll, and my Financial Institution (Bank), indicated below, to credit my account
I hereby authorize Lake Worth Independent School District to initiate credit entries and to
I hereby authorize Lam Dermatology and Associates to use and/or disclose my protected health
I hereby authorize LAMBS & IVY to include my child
I hereby authorize Lancaster County Career & Technology Center to initiate Direct Deposit
I hereby authorize Langham Place, Fifth Avenue to charge the following on my credit card:
I hereby authorize Langley Fastball Association to charge my credit card $150, per child, for
I hereby authorize LANTANA COMMUNICATIONS CORP to initiate automatic debit entries to the account listed below
I hereby authorize Laramie County Community College to release all information for the 20-20 and 20-20 academic
I hereby authorize Laramie County Community College to release all information regarding
I hereby authorize Lee s MarketPlace and the financial institutions shown below to deposit my pay
I hereby authorize Leon ISD to initiate and to make credit entries or reversing entries and to
I hereby authorize Lexington-Fayette Urban County Government to initiate the
I hereby authorize LHLSD, hereinafter called COMPANY, to initiate credit entries and to initiate, if necessary any debit entries and
I hereby authorize Liberty National Life Insurance Company to deposit my annuity withdrawal
I hereby authorize Lien-Pro Inc
I hereby authorize Lilliput Early Childhood Center to administer the following medication to my child
I hereby authorize Limitless Physical Therapy
I hereby authorize Lincoln Park Public Schools (the company, hereinafter referred to as the company)
I hereby authorize LoginClinics, PLLC to disclose my individually identifiable health information as described below
I hereby authorize Lois Carani, MD, LLC to receive and /or release the following Protected Health Information:
I hereby authorize Loudoun Rheumatology Center to release to:
I hereby authorize Louisiana State University (LSU) to initiate credit entries or reversing entries and to make adjustments for any
I HEREBY AUTHORIZE LOYAL BANK LTD TO EXECUTE THE BELOW
I hereby authorize Loyola Credit Union to pay
I hereby authorize lPalomar Medical Center ... - Palomar Health
I hereby authorize Lutheran Brethren Conference Center, hereafter called the Company, to initiate
I hereby authorize LYNK Capital, LLC and/or its subsidiaries to electronically debit my checking
I hereby authorize M
I hereby authorize M acomb County Community M ental Health to (release / exchange / request)
I hereby authorize Main Line Pediatric Therapy Center, Inc
I hereby authorize Manatee County Government to charge the designated credit card below for payment of the referenced transaction
I hereby authorize Manatee County YMCA, 1023 Manatee Ave
I hereby authorize Mandarin Oriental, Washington D
I hereby authorize Mandy Menzer, Psy
I hereby authorize Manhattan Transfer Registrar Co. to update ...
I hereby authorize Maple Valley Pediatric Therapy, a Division of Relaxing Resources, PLLC to
I hereby authorize Margolin & Keinarth, M
I hereby authorize Mark E
I hereby authorize Mark Tickle Family and Implant Dentistry to publish photographs taken of
I hereby authorize Market South Management to investigate the information supplied by me and all inquires it deems necessary to verify and
I hereby authorize Marshall Medical Center (name of facility sending medical information
I hereby authorize Marshall Medical Center to disclose the following information from
I hereby authorize MARY QUEEN OF THE HOLY ROSARY to initiate the direct debit of TUITION to the account listed below - maryqueenschool
I hereby authorize Maybank to debit my Maybank Visa or ... -...
I hereby authorize Maythal Eshaghian, Licensed Marriage & Family Therapist (MFT
I hereby authorize me employer Altman Specialty Plants, (hereinafter COMPANY) to deposit any amounts owed my by initiating credit entries to my account at the financial institute (hereinafter BANK) indicated below
I hereby authorize MedExpress, located at , to use and/or disclose the above-named individual s
I hereby authorize MedExpress, located at , to use andor disclose the abovenamed individuals
I hereby authorize Medford Area Public School District, hereinafter called DISTRICT, to initiate credit entries to
I hereby authorize Medford Womens Clinic to leave detailed, personal health information by the
I HEREBY authorize medical information regarding the above identified person to be released
I hereby authorize MedNow Urgent Care Center to disclose my individually identifiable health information - mednowurgentcare
I hereby authorize Mercer County School District #404 to initiate credit entries to the
I hereby authorize Meridian Behavioral Healthcare, Inc
I hereby authorize MERIL to initiate automatic deposits to my account at the financial institution named below
I hereby authorize Metro Medical Credit Union to initiate (Debit/Credit) entries to my Metro Medical Credit Union Account below and the financial
I hereby authorize Michael D
I hereby authorize Michael Tralla MD to use or disclose my Personal Health Information (PHI) as
I hereby authorize Michigan State University to release the following educational record information:
I hereby authorize Midland Independent School District to initiate credit entries to my (select one)
I hereby authorize Midwest Center for Womens HealthCare to release/receive my medical
I hereby authorize Midwest Sanitation to initiate debit entries and to ...
I hereby authorize Midwestern State University and/or its authorized agent(s) or third party vendor to obtain information relating to my criminal
I hereby authorize MINUTEMAN REG
I hereby authorize Missouri Baptist Foundation hereafter called COMPANY, to initiate
I hereby authorize Missouri Gas Energy, a division of Southern Union Company (MGE) Kansas City Power - kcenergy
I hereby authorize MITAGS to release to the Union and to the steamship company by which I am employed, or desire to be employed, all information relating to my training record - mitags-pmi
I hereby authorize Modern Plumbing Industries, Inc
I hereby authorize Monster Entertainment LLC to initiate automatic debits to my account at the financial
I hereby authorize Montgomery College, Payroll Office to deposit my net pay automatically to the account at
I hereby authorize Montgomery College, Payroll Office to deposit my net pay automatically to the account at the financial - esfcu
I hereby authorize Morrisville Eaton CSD, hereinafter called Company, to make a payment
I hereby authorize Mortgage Services III, LLC (MSI) to verify my past and present employment,
I hereby authorize MOUNT ZION BAPTIST CHURCH to receive any criminal history
I hereby authorize Mountain View Eye Center to (PLEASE INITIAL):
I hereby authorize MP Singapore Pte Ltd to charge my credit card as stated below for payment for participation at
I hereby authorize Mr
I HEREBY AUTHORIZE MY Attending Physician and/or hospital to release