Authorization for Release of Medical Information


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Signature Certificate
Document name: Authorization for Release of Medical Information
lock iconUnique Document ID: 95979beec8bde231fd555a4c357bed81a899d8e9
Timestamp Audit
April 21, 2022 1:49 am EDTAuthorization for Release of Medical Information Uploaded by TruReleaf MD LLC - records@trureleafmd.com IP 68.204.75.176
April 27, 2022 5:21 pm EDTTruReleafMD Records - records@mmtclinics.com added by TruReleaf MD LLC - records@trureleafmd.com as a CC'd Recipient Ip: 35.141.6.16
July 27, 2022 3:18 pm EDTTruReleafMD Records - records@mmtclinics.com added by TruReleaf MD LLC - records@trureleafmd.com as a CC'd Recipient Ip: 72.223.102.46
July 28, 2022 1:09 pm EDTTruReleafMD Records - records@mmtclinics.com added by TruReleaf MD LLC - records@trureleafmd.com as a CC'd Recipient Ip: 118.179.17.158
July 28, 2022 1:10 pm EDTTruReleafMD Records - records@mmtclinics.com added by TruReleaf MD LLC - records@trureleafmd.com as a CC'd Recipient Ip: 118.179.17.158
July 29, 2022 2:46 am EDTTruReleafMD Records - records@mmtclinics.com added by TruReleaf MD LLC - records@trureleafmd.com as a CC'd Recipient Ip: 35.141.6.16
July 29, 2022 3:07 am EDTTruReleafMD Records - records@mmtclinics.com added by TruReleaf MD LLC - records@trureleafmd.com as a CC'd Recipient Ip: 35.141.6.16
July 29, 2022 1:16 pm EDTTruReleafMD Records - records@mmtclinics.com added by TruReleaf MD LLC - records@trureleafmd.com as a CC'd Recipient Ip: 118.179.17.158
July 29, 2022 1:23 pm EDTTruReleafMD Records - records@mmtclinics.com added by TruReleaf MD LLC - records@trureleafmd.com as a CC'd Recipient Ip: 118.179.17.158
May 3, 2023 6:04 pm EDTTruReleafMD Records - records@mmtclinics.com added by TruReleaf MD LLC - records@trureleafmd.com as a CC'd Recipient Ip: 68.204.75.176