{"id":374,"date":"2020-10-11T23:02:31","date_gmt":"2020-10-11T23:02:31","guid":{"rendered":"http:\/\/susongderm.com\/newsite\/?page_id=374"},"modified":"2023-02-09T02:25:15","modified_gmt":"2023-02-09T02:25:15","slug":"authorization-privacy-form","status":"publish","type":"page","link":"https:\/\/susongderm.com\/forms\/authorization-privacy-form\/","title":{"rendered":"Authorization and Privacy Form"},"content":{"rendered":"\t\t
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Authorization and Privacy Form<\/h2>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
Online New Patient Forms<\/p>\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t\n\t\t\t\t\t\t
\n\t\t\t\t\t\tPlease fill all forms out as thoroughly as possible. By initialing or typing your name in the \"Signature\" and \"Initial\" text boxes, you are authorizing and giving Susong Dermatology permission to access your personal health information. For assistance with the forms, please contact us at (423)870-3376. \t\t\t\t\t<\/p>\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\n\t\t\t\t\t\t