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Representative is usually the person filling out this form. The undersigned health care provider may revoke this authorization or change the fax number, provided that the undersigned health care provider gives LabCorp reasonable written notice. Partial Results Finals Only.

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Partial Results Finals Only. The undersigned health care provider may revoke this authorization or change the fax number, provided that the undersigned health care provider gives LabCorp reasonable written notice.


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Representative is usually the person filling out this form. The undersigned health care provider may revoke this authorization or change the fax number, provided that the undersigned health care provider gives LabCorp reasonable written notice.

Seperate accounts using a comma ,. LabCorp strongly encourages all clients to physically safeguard fax machines, so that the location, access, and use of such machines comply with all HIPAA requirements.

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Representative is usually the person filling out this form. LabCorp strongly encourages all clients to physically safeguard fax machines, so that the location, access, and use of such machines comply with all HIPAA requirements. Partial Results Finals Only. Provide Area Code with each fax number. Seperate accounts using a comma ,.
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  1. Representative is usually the person filling out this form. LabCorp strongly encourages all clients to physically safeguard fax machines, so that the location, access, and use of such machines comply with all HIPAA requirements.