EFTA00308055Set 9
11p3,765w
Patient (Parent/Guardian) Signature Date
EFTA00308059
, NYU Langone
Health
HEALTH INFORMATION EXCHANGE,
CARE EVERYWHERE AND HEALTHIX
CONSENT FORM
In this Consent Form, you can choose whether to allow the health care
https://www.justice.gov/epstein/files/DataSet%209/EFTA00308055.pdf