Common Contracts
1 similar Patient Service Agreement contracts
Account#:Patient Service Agreement • March 24th, 2017
Authorization/Consent to Provide Home Medical (Durable Medical) Equipment: I have been informed of the home medical (durable medical) equipment and supplies available to me and of the selection of providers from which I may choose. I authorize Atos Medical Inc under the direction of the prescribing physician, to provide home medical equipment and supplies as prescribed by my physician.
