Drwasson

Nazareth Office Brochure 20081020

534 S. Main Street Nazareth, PA 18064 Board Certified in Internal Medicine Phone: (610) 746-1860 Fax: (610)746-5068 Visit us on the web at: www.drwasson.com James C. Wasson, M.D., P.C. James C. Wasson, M.D., P.C. 534 S. Main Street Nazareth, PA 18064 Board Certified Primary Care Physician School Doctor Private Practice ...

www.drwasson.com

AUTHORIZATION TO RELEASE HEALTH CARE INFORMATION

JAMES C. WASSON, M.D., P.C. 534 SOUTH MAIN STREET NAZARETH, PA 18064 610-746-1860 DRWASSON@DRWASSON.COM AUTHORIZATION TO RELEASE HEALTH CARE INFORMATION Patient's Name: Date of Birth: Previous Name: Social Security #: I request and authorize to release health care information of the patient ...

www.drwasson.com

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