Providers:
JULIO A SAVINON MD | EDDY BERGES-CHEZ MD
Maricruz Bloomquist APRN,MSN,FNP-BC | Kady Marie Vega APRN,MSN,FNP-C
I authorize RIO GRANDE MEDICINE, to release any or all medical information about me including AIDS/HIIV test results and diagnosis; drug/alcohol abuse, and Psychiatric diagnosis and treatment record to my insurance company(s).
I request that authorized Medicare benefits, or other insurance benefits, be made on my behalf to any of the above named physicians/providers for medical services rendered.
Please note:
