schwarzentraubfootclinic.comassignment/authorization i hereby assign all medical and/or surgical...

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Page 1: schwarzentraubfootclinic.comAssignment/Authorization I hereby assign all medical and/or surgical benefits to include major medical benefits to which I am entitled, including Medicare,
Page 2: schwarzentraubfootclinic.comAssignment/Authorization I hereby assign all medical and/or surgical benefits to include major medical benefits to which I am entitled, including Medicare,
Page 3: schwarzentraubfootclinic.comAssignment/Authorization I hereby assign all medical and/or surgical benefits to include major medical benefits to which I am entitled, including Medicare,
Page 4: schwarzentraubfootclinic.comAssignment/Authorization I hereby assign all medical and/or surgical benefits to include major medical benefits to which I am entitled, including Medicare,