Muslims with nukes are like a monkey with a granade.
SO, I HAVE WRITTEN, I DO NOT KNOW WHAT ELSE TO SAY, SO IF YOU NEED MORE ANSWERS WRITE AND EMAIL
WRITE AND EMAIL THANK YOU
I HAVE EXPLAINED THE SITUATION, NOT JUST THE SAFETY ISSUES, AND ALL EMAILS WERE SENT TO YOU ALLEGEDLY BY OLIVERIA AND RYAN, AND GOV. WHT DO YOU NOT HAVE??
SPRAIN NECK, SPRAIN FOOT, RIGHT WRIST, AND DOG INJURIES, AND CARRIOR MANGLED.
MARY RAN THRU STOP LIGHTS TWO., ON THE FLOOR, COULD NOT GET UP., AND I AM HANDICAP AS WELL., C3C4 PLATE IN NECK, AND THT IS THE CONCERN I DO NOT WANT ANY LONG TERM DAMAGES., SAVVY
500K LAW SUITE.PLATE IN NECK, AND DEAD CHILDS BONE COSTLY, AND I DO NOT WANT SOMEONE TO STATE OH 'THIS LOOKS LIKE THE INJURY IN 2013 CAUSED THE CRACK, NO' DR. MENTIONED 'YOU COULD HAVE BEEN PARAPLEGIC LUCKY TO WORN YOUR BRACE.'AUTHORIZATION TO DISCLOSE HEALTHINFORMATIONHIPAA COMPLIANT PURSUANT TO Section Code 164.508
Patient Name: Yvette Marion_(HANDFIELD Date of Birth:
Patient Address:___9524 penstemon court_________80920__
Claim #:_684-444695-001_____ Medical Record Number (if applicable):I HEREBY GRANT PERMISSION TO AND AUTHORIZE THE USE OR DISCLOSURE OF THE ABOVE NAMED INDIVIDUALíS RECORDS AS DESCRIBED BELOW TO AIG Domestic Claims, Inc, and/or AIU Holdings, Inc.(ONLY MEMORIAL HOSPITAL RECORDS, COLORADO SPRINGS, CO 80920 SEPT 13 RECORDS ONLY)NO REASON WHY AFFILIATED COMPANIES SHOULD BE INVOLVED. AIG ONLY WITH THE AGENT PATTY FERGUSON
THE FOLLOWING INDIVIDUAL(S), MEDICAL PROVIDER(S), AND/OR ORGANIZATION(S) ARE AUTHORIZED TO MAKE THE DISCLOSURE:Name
Address & Phone Number
Date Range of Treatment Requested
MEMORIAL COLSPR ER 80920
MEMORIAL HOSPITAL ER ONLY
SPECIFY RECORDS: You must check the box and initial below to specify which type of information to be disclosed
X MEDICAL INFORMATION (All Medical reports including but not limited to SOAPE notes, all other notes (typed or
handwritten), records, charts, any letters, physical therapy records, lab reports and outpatient reports and discharge summary)
X MEDICAL BILLING
X X-RAYS/FILMS (MRIís, CT-Scans, and Reports)
X Exclusions: JUST THE ER HOSPITAL OF MEMORIAL SEPT 2013.__COLORADO SPRINGS, CO 80920 ( AND PET SMART, AIR ACADEMY, 80920 VET FOR THE DOG INJURED.
The above information is being obtained to assist said authorized entities in evaluating my claim for benefits or damages. A copy or facsimile of this document shall be considered as effective and valid as the original.
REVOCATION: I understand that I have the right to revoke this authorization at any time. I understand that if I revoke this Authorization I must do so in writing and present my written revocation to the health information management department. I understand that revocation will not apply to my insurance company when the law provides my insurer with the right to contest a claim under my policy.DURATION: Unless otherwise revoked, this Authorization will expire on the following date, event or condition: EXP date of signature_.EXPIRE: IN DEC 29, 2013. The covered entity cannot require the patient to sign the authorization in order to receive treatment or payment or to enroll or be eligible for benefits.
RE-DISCLOSURE: I understand that authorizing the disclosure of this health information is voluntary and that I am entitled to a copy of this authorization and acknowledge receipt of a copy thereof. I can refuse to sign this Authorization. I understand any disclosure of information carries with it the potential for an unauthorized re-disclosure and the information may not be protected by federal confidentiality rules. NO OTHER OR OUTSIDE DISCLOSURE OF THE INFORMATION. ESQ., ONLY TO AIG., AIG WILL BE LIABLE IF THERE IS UNPROPER DISCLOSURE OUTSIDE.YVETTE ANNE MARION HANDFIELD