Access and Authorization for Use and/or Disclosure of Protected Health Information
I authorize Dr. Yolanda Cintron DMD, PA to release confidential health information including but not limited to X-rays, photos, clinical findings, treatment notes , lab reports, medical histories, medications and other by email, phone, fax, and mail. I am giving permission to discuss post op instructions with your chosen responsible party that will be picking you up when you are sedated.