FINANCIAL AGREEMENT AND HIPAA CONSENTFinancial Agreement and Hipaa Consent • January 21st, 2020
AUTHORIZATION FOR PATIENT CARE: The undersigned patient and/or representative (“Undersigned”) hereby grants permission to the employees of Trinity Medical, WNY to render routine patient care, and to carry out the orders of the patient’s physician, consultants, associates, and assistants of the Undersigned’s choice.