DAY KIMBALL MEDICAL GROUP, INC.Authorization for Basic Treatment • October 17th, 2012
This is an agreement between you and Day Kimball Healthcare (DKH). It contains your agreement to pay for all services you will receive from DKH. It also addresses the use of your medical records (and other information about "you", "your"), insurance benefits, and certain conditions in regard to your treatment. In consideration of receiving services, you agree as follows: