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 · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group

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Page 1:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 2:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 3:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 4:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 5:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 6:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 7:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 8:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 9:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 10:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 11:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 12:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 13:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 14:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 15:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 16:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 17:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 18:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 19:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 20:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group
Page 21:  · DOthers (i.e. spouse, family, friends): I understand I have a right to revoke this authorization in writing except to the extent that Bayfront Health Medical Group

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