Medicare Portal Authorization - Helene Price


AUTHORIZATION

I, , GIVE PERMISSION TO THE LAW OFFICE OF ROSENBAUM AND ASSOCIATES, TO SET UP A CLAIM AND OBTAIN MY MEDICARE INFORMATION FOR THIS CLAIM FROM THE MY MEDICARE PORTAL FOR THE DURATION OF THIS CLAIM FOR THE ACCIDENT OF .
DATE:  

My user name and password is as follows:
USERNAME: __________________________________ PASSWORD: __________________________________ 

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Signature Certificate
Document name: Medicare Portal Authorization - Helene Price
lock iconUnique Document ID: 588cba0b3394e28883c6a82a54e0fcab294307ac
Timestamp Audit
May 19, 2020 8:46 pm GMTMedicare Portal Authorization - Helene Price Uploaded by David Rosenbaum - test@rosenbaumfirm.com IP 68.80.162.82
May 20, 2020 11:57 pm GMTHelene Price - hprice@rosenbaumfirm.com added by David Rosenbaum - test@rosenbaumfirm.com as a CC'd Recipient Ip: 68.80.162.82
May 21, 2020 4:28 am GMTHelene Price - hprice@rosenbaumfirm.com added by David Rosenbaum - test@rosenbaumfirm.com as a CC'd Recipient Ip: 68.80.162.82
May 21, 2020 4:49 am GMTHelene Price - hprice@rosenbaumfirm.com added by David Rosenbaum - test@rosenbaumfirm.com as a CC'd Recipient Ip: 68.80.162.82