div class=ts-pagebutton class=gotoPage data-page=1Page 1button div class=ts-imageimg data-url=carteret-heart-and-vascular-home-i-authorize-payment-of-medical-benefits-to-thehtmlpage=1 data-page=1 class=ts-thumb lazyload alt=Page 1: Carteret Heart and Vascular - Home€¦ · I authorize payment of medical benefits to the undersigned physician or supplier of services described Patient signature Date CARTERET loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader036vdocumentsusreader036viewer20220710215fd5f34ed12c47122e26b352html5thumbnails1jpg width=140 height=200 divdivdiv class=ts-pagebutton class=gotoPage data-page=2Page 2button div class=ts-imageimg data-url=carteret-heart-and-vascular-home-i-authorize-payment-of-medical-benefits-to-thehtmlpage=2 data-page=2 class=ts-thumb lazyload alt=Page 2: Carteret Heart and Vascular - Home€¦ · I authorize payment of medical benefits to the undersigned physician or supplier of services described Patient signature Date CARTERET loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader036vdocumentsusreader036viewer20220710215fd5f34ed12c47122e26b352html5thumbnails2jpg width=140 height=200 divdivdiv class=ts-pagebutton class=gotoPage data-page=3Page 3button div class=ts-imageimg data-url=carteret-heart-and-vascular-home-i-authorize-payment-of-medical-benefits-to-thehtmlpage=3 data-page=3 class=ts-thumb lazyload alt=Page 3: Carteret Heart and Vascular - Home€¦ · I authorize payment of medical benefits to the undersigned physician or supplier of services described Patient signature Date CARTERET loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader036vdocumentsusreader036viewer20220710215fd5f34ed12c47122e26b352html5thumbnails3jpg width=140 height=200 divdivdiv class=ts-pagebutton class=gotoPage data-page=4Page 4button div class=ts-imageimg data-url=carteret-heart-and-vascular-home-i-authorize-payment-of-medical-benefits-to-thehtmlpage=4 data-page=4 class=ts-thumb lazyload alt=Page 4: Carteret Heart and Vascular - Home€¦ · I authorize payment of medical benefits to the undersigned physician or supplier of services described Patient signature Date CARTERET loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader036vdocumentsusreader036viewer20220710215fd5f34ed12c47122e26b352html5thumbnails4jpg width=140 height=200 divdivdiv class=ts-pagebutton class=gotoPage data-page=5Page 5button div class=ts-imageimg data-url=carteret-heart-and-vascular-home-i-authorize-payment-of-medical-benefits-to-thehtmlpage=5 data-page=5 class=ts-thumb lazyload alt=Page 5: Carteret Heart and Vascular - Home€¦ · I authorize payment of medical benefits to the undersigned physician or supplier of services described Patient signature Date CARTERET loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader036vdocumentsusreader036viewer20220710215fd5f34ed12c47122e26b352html5thumbnails5jpg width=140 height=200 divdiv
