Common Contracts
2 similar Authorization and Consent Agreement contracts
AUTHORIZATION and CONSENT AGREEMENTAuthorization and Consent Agreement • December 1st, 2020
This consent form authorizes Premier Wellness Clinics to obtain and review my prescription history. Detailed prescription history provides your Medical Practitioner with information about medications being prescribed by other providers in your medical care. This information will improve the accuracy of our medication list in your medical chart and decrease any adverse drug reactions or inaccurate medication information such as drug names or dosages.
AUTHORIZATION and CONSENT AGREEMENTAuthorization and Consent Agreement • October 30th, 2020
This consent form authorizes Premier Wellness Clinics to obtain and review my prescription history. Detailed prescription history provides your Medical Practitioner with information about medications being prescribed by other providers in your medical care. This information will improve the accuracy of our medication list in your medical chart and decrease any adverse drug reactions or inaccurate medication information such as drug names or dosages.
