Bmmc-fax Cover Sheet

  • May 2020
  • PDF

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  • Words: 235
  • Pages: 1
73 Sipprelle Dr, Ste K Parachute, CO 81635 Office 970-285-7046 Fax 970-285-6064

Battlement Mesa Medical Center

Fax To:

Re:

Fax:

# pages including cover :

Phone:

Date:

As requested

From:

For Review

For Signature

Please Reply

Call with questions

Dr. Henry Kiang

______

Ginny

______

Dr. Kevin Coleman

______

Brittanie

______

Carol Welden

______

Becky

______

Marisol

______

Millie

______

Diane

______

Lois Kame

______

Comments:_______________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________

NOTICE TO RECIPIENT: The information contained in this facsimile message is privileged and confidential information intended for the use of the individual or entity named above. If the reader of this message is not the intended recipient or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any use, review, dissemination, distribution or copying of this communication is strictly prohibited. If you have received this facsimile in error, please notify us by telephone immediately so that we can arrange for the retrieval of the faxed documents at no cost to you. The information may have been disclosed to you from records whose confidentiality may be protected by federal law. Federal regulation (42-CFR-Part 2) prohibit you from making any further disclosure of it without the specific written consent of the person to whom it pertains, or as otherwise permitted by such regulations; a general authorization for release of medical records or other information may not be sufficient for this purpose.

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