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Medical Documents - Prezi Template

3D Prezi Template with a medical and healthcare theme. Clipboard, syringe, papers, thermometer, a drug container and test tubes on a wooden table and hospital background. Get this Prezi Template from Prezibase.com
by

Prezi Templates by Prezibase

on 19 January 2016

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Transcript of Medical Documents - Prezi Template

I understand that my records are confidential and cannot be disclosed without my written authorization, except when otherwise permitted by law. Information used or disclosed pursuant to this authorization may be subject to re-disclosure by the recipient and no longer protected. I understand that the specified information to be released may include but is not limited to history, diagnoses, and/or treatment of drug or alcohol abuse, mental illness, or communicable disease, including HIV and AIDS.

I understand that I may revoke this authorization in writing at any time except to the extent that action has been taken in reliance upon the authorization.

The authorization will expire six (6) months from the date of my
signature, unless I revoke the authorization prior to that time
Example Medical Document
Name:
Signature:
Date:
(Doctor, Hospital, Attorney, Insurance Company, Self, etc.) Phone Number
Address (Street, City, State and ZIP)
Printed Name of Patient or Legally Authorized Representative
Occupation
I authorize and request the disclosure of all protected information for the purpose of review and evaluation in connection with a legal claim. I expressly request that the designated record custodian of all covered entities under HIPAA identified above disclose full and complete protected medical information including the following:
All employment, personnel or wage records. All autopsy, laboratory, histology, cytology, pathology, immunohistochemistry records and specimens; radiology

Records and films including CT scan, MRI, MRA, EMG, bone scan, myleogram; nerve conduction study, echocardiogram and cardiac catheterization results, videos/CDs/films/reels and reports.
I am a(n):
animal
idiot
dancer
human
Please fill in the details:
I urgently need:
coffee
a job
cupcakes
treatment
I authorize and request the disclosure of all protected information for the purpose of review and evaluation in connection with a legal claim. I expressly request that the designated record custodian of all covered entities under HIPAA identified above disclose full and complete protected medical information including the following:
Mike Miller
05.05.2016
Medical Themed Prezi template
PRESENT INFORMATION, DOCUMENTS, SERVICES...
ADD YOUR OWN CONTENT ANYWHERE
In this template you can add your own:
texts
images
videos
symbols
I urgently need:
coffee
a job
cupcakes
treatment
Reg: 235240529567 EOP
12.7.2016 ID: 34.233.21.3493
1
2
Zoom in to present
the details of your presentation
Promote Products or Services:
ALL SEPARATED
DESIGN
ELEMENTS:
CUSTOMIZE & DELETE THE ELEMENTS YOU DON'T NEED
Get this Prezi Template from:
http://prezibase.com
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"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum."
"Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum."
CREATIVITY:
99%
Full transcript