You can read the full Patient Authorization for Use and Disclosure of Protected Health Information at cabinethealth.com/pages/patient-authorization.
*By selecting the box on behalf of the patient, as representative or guardian, I attest that I am legally able to sign such documents on the patient’s behalf and am properly acting in my capacity in doing so. Proof of such guardian’s or representative’s authority to act for the patient may be requested such as power of attorney or legal court order.