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: 5d260a314d7c3a7c684f00c7384bb3a585ec23d6
Timestamp Audit
June 7, 2021 10:53 EDTRecords 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 EDTRecords 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 EDTAuthorization for Release of Medical Information for Ketamine Treatment Uploaded by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com IP 98.230.97.229
June 24, 2021 15:20 EDTRecords 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 EDTRecords 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 EDTRecords 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 EDTRecords 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 EDTRecords 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 EDTRecords 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 EDTRecords Admin - records@newhorizonclinics.com added by New Horizon Infustion Ketamine Clinic - records@newhorizonclinics.com as a CC'd Recipient Ip: 98.230.97.229