· pdf filethat my revoking this authorization will not affect my health care treatment or...

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Page 1: · PDF filethat my revoking this Authorization will not affect my health care treatment or enrollment under a health plan. ... Pregnant or Nursing ... Headach/Migraine Tremor
Page 2: · PDF filethat my revoking this Authorization will not affect my health care treatment or enrollment under a health plan. ... Pregnant or Nursing ... Headach/Migraine Tremor
Page 3: · PDF filethat my revoking this Authorization will not affect my health care treatment or enrollment under a health plan. ... Pregnant or Nursing ... Headach/Migraine Tremor
Page 4: · PDF filethat my revoking this Authorization will not affect my health care treatment or enrollment under a health plan. ... Pregnant or Nursing ... Headach/Migraine Tremor
Page 5: · PDF filethat my revoking this Authorization will not affect my health care treatment or enrollment under a health plan. ... Pregnant or Nursing ... Headach/Migraine Tremor