Authorization for Release of Medical Information for Ketamine Treatment


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Signature Certificate
Document name: Authorization for Release of Medical Information for Ketamine Treatment
lock iconUnique Document ID: c34dd5614938673f2b1d96af8cd075e038ffde64
Timestamp Audit
June 7, 2021 10:53 ESTRecords Admin - records@mmtcfl.com added by New Horizon Infustion Ketamine Clinic - Marc@MarcTECH360.com as a CC'd Recipient Ip: 98.230.97.229, 127.0.0.1
June 7, 2021 11:40 ESTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - Marc@MarcTECH360.com as a CC'd Recipient Ip: 98.230.97.229, 127.0.0.1
June 7, 2021 14:45 ESTAuthorization for Release of Medical Information for Ketamine Treatment Uploaded by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com IP 35.141.6.16
June 24, 2021 15:20 ESTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com as a CC'd Recipient Ip: 98.230.97.229, 127.0.0.1
July 20, 2021 12:33 ESTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com as a CC'd Recipient Ip: 24.214.29.124
July 20, 2021 12:36 ESTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com as a CC'd Recipient Ip: 24.214.29.124
July 20, 2021 15:31 ESTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com as a CC'd Recipient Ip: 24.214.29.124
September 15, 2021 15:00 ESTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com as a CC'd Recipient Ip: 98.230.97.229
September 15, 2021 15:16 ESTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com as a CC'd Recipient Ip: 98.230.97.229
September 15, 2021 15:22 ESTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com as a CC'd Recipient Ip: 98.230.97.229
July 28, 2022 02:15 ESTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com as a CC'd Recipient Ip: 35.141.6.16
July 29, 2022 02:55 ESTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com as a CC'd Recipient Ip: 35.141.6.16
July 29, 2022 03:21 ESTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com as a CC'd Recipient Ip: 35.141.6.16
September 19, 2022 18:19 ESTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com as a CC'd Recipient Ip: 35.141.6.16