MidAtlantic Pulmonary Clinic:Maria L. Jison

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PHONE 888-340-3330 FAX 240-489-6262 . PATIENT AUTHORIZATION TO . DISCLOSE PERSONAL HEALTH INFORMATION. I release Mid-Atlantic Pulmonary Clinic/Maria L. Jison, MD, LLC, and the Recipient/Discloser listed above, and any of their providers and staff from all responsibility or liability that may arise from this authorization. I may withdraw this

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PHONE 888-340-3330 FAX 240-489-6262 PATIENT AUTHORIZATION TO DISCLOSE PERSONAL HEALTH INFORMATION. Mid-Atlantic Pulmonary Clinic Maria L. Jison, MD, LLC PATIENT NOTICE OF PRIVACY PRACTICES This notice describes how medical information about you may be used and disclosed and how