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The undersigned health care benefactor hereby authorizes Lab firm and its subsidiaries to send away patient protected health selective information (PHI) as defined by HIPAA (Health insurance policy movableness and Accountability Act of 1996) to the fax act listed below. Additionally, the undersigned health work bourgeois understands that it has deemed such that sending is necessary for the purposes of well-being care treatment, payment, and/or status care operations. The undersigned health tending helper may revoke this authority or change the fax number, provided that the undersigned status care provider gives Lab Corp reasonable scrawled notice.