KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office.

Page 1 <img data-url='document/km-c368-20180308160302-chiropractor-in-middlesboro-ky-authorization-and-release.html?page=1' data-page='1' class='cut-thumb lazyload' alt='Page 1: KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office.' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader033.cupdf.com/reader033/viewer/2022050211/5f5d6597a1b5c52e1802c534/html5/thumbnails/1.jpg' width='140' height='200' /> Page 2 <img data-url='document/km-c368-20180308160302-chiropractor-in-middlesboro-ky-authorization-and-release.html?page=2' data-page='2' class='cut-thumb lazyload' alt='Page 2: KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office.' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader033.cupdf.com/reader033/viewer/2022050211/5f5d6597a1b5c52e1802c534/html5/thumbnails/2.jpg' width='140' height='200' /> Page 3 <img data-url='document/km-c368-20180308160302-chiropractor-in-middlesboro-ky-authorization-and-release.html?page=3' data-page='3' class='cut-thumb lazyload' alt='Page 3: KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office.' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader033.cupdf.com/reader033/viewer/2022050211/5f5d6597a1b5c52e1802c534/html5/thumbnails/3.jpg' width='140' height='200' /> Page 4 <img data-url='document/km-c368-20180308160302-chiropractor-in-middlesboro-ky-authorization-and-release.html?page=4' data-page='4' class='cut-thumb lazyload' alt='Page 4: KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office.' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader033.cupdf.com/reader033/viewer/2022050211/5f5d6597a1b5c52e1802c534/html5/thumbnails/4.jpg' width='140' height='200' /> Page 5 <img data-url='document/km-c368-20180308160302-chiropractor-in-middlesboro-ky-authorization-and-release.html?page=5' data-page='5' class='cut-thumb lazyload' alt='Page 5: KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office.' loading='lazy' src='data:image/gif;base64,iVBORw0KGgoAAAANSUhEUgAAAAEAAAABCAYAAAAfFcSJAAAADUlEQVR42mNk+P+/HgAFhAJ/wlseKgAAAABJRU5ErkJggg==' data-src='https://reader033.cupdf.com/reader033/viewer/2022050211/5f5d6597a1b5c52e1802c534/html5/thumbnails/5.jpg' width='140' height='200' />

KM C368-20180308160302 - Chiropractor in Middlesboro, KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office.

Documents