div class=ts-pagebutton class=gotoPage data-page=1Page 1button div class=ts-imageimg data-url=pdf-assignment-and-release-i-certify-that-i-have-insurance-coverage-with-namehtmlpage=1 data-page=1 class=ts-thumb lazyload alt=Page 1: ASSIGNMENT AND RELEASE I certify that I have insurance coverage with Name of Insurance Companyies and assign directly to Dr all insurance benefits if any otherwise payable to loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader031vdocumentsusreader031viewer20220304145aa04c707f8b9a84178df29ehtml5thumbnails1jpg width=140 height=200 divdivdiv class=ts-pagebutton class=gotoPage data-page=2Page 2button div class=ts-imageimg data-url=pdf-assignment-and-release-i-certify-that-i-have-insurance-coverage-with-namehtmlpage=2 data-page=2 class=ts-thumb lazyload alt=Page 2: ASSIGNMENT AND RELEASE I certify that I have insurance coverage with Name of Insurance Companyies and assign directly to Dr all insurance benefits if any otherwise payable to loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader031vdocumentsusreader031viewer20220304145aa04c707f8b9a84178df29ehtml5thumbnails2jpg width=140 height=200 divdiv