Laserfiche WebLink
D.AYMAR W <br />Iinuovery Snrvienn <br />CABARRUS CENTER <br />1305 S. CANNON BLVD. <br />KANNAPOLIS, NC 28083 <br />(704)939-1100 <br />(70A) 938-1120 (fax) <br />FAX COVER SHEET <br />CONFIDENTIAL HEALTH INFORMATION ATTACHEp <br />CONFIDENTIALITY/RBDISCLOSURE NO71CE: The documents acaompanying this fax transmission contain confidential <br />and privileged health Informatfon.' Health information Is personal and sensitive Informalfon related to a person's health <br />care and is protected by state and fedaral regulations. it Is being faxed after appropriate authorization from the client or <br />under circumstences that don't requite clienl authorization. Tfie reciplent is obfigated to maintain if in a safe, secure and <br />confidential manner. If you are the intended recipient, or if you are NOT the Intended recipient, you are hereby notified <br />that any redisclosure of the confidentiaf informat{on is STRICT4Y PROHIBITED without an additionai valid authorization. <br />If you are NOT the intended reciplent, piease immediately notify the sender at (704) 847-9500 to arranga for return of the <br />documents, <br />Date: ~f~ll l.Z v G'~7 <br />To: IY~a~ ~u~c~~"S <br />Fax: `7aY' ~~Zv-~Sr~l <br />Company Name: _("_aGlr. ~~ v s C a. ~o'v . <br />Telephone: 7~' `1 ~ ~2 ~ ` ~ 13 ~ <br />From: ~~~~ ~ Vv~ 5'7 Number of pages (inGuding this fax cover): <br />Message and/or description offaxe material,/:~ ~ <br />d ~ct c:~ /-Q '~-Pr ~xp~ v~ ~ '1/'-RW .r.C^-~-rvrs~~- <br />TO 6E COMPLETED PRIOR TO EAXING INFORMATION: ~~~ <br />~c~.1~5 <br />Authorization verified and on file: Yes No ~~~ ~~ <br />Name of person contacted prior to transmission: ~T-~' %/ ~ (~/~v <br />Daie: Time: Name of staff conta t nic g ith s person: <br />Inform the recipient or contact person to call the sender if faxed information is not received. After entering <br />number into facsimi4e machine, verlfy that the number is correct prior to sending documents. <br />G-~N <br />