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 .
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Document name: Medicare Portal Authorization - Jeanette Keller

Unique Document ID: fe0719a66725799bd4c46b6914f8507be0b8f7c8

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Timestamp	Audit
June 30, 2020 6:15 pm GMT	Medicare Portal Authorization - Jeanette Keller Uploaded by David Rosenbaum - test@rosenbaumfirm.com IP 162.221.24.2
June 30, 2020 6:16 pm GMT	Jeanette Keller - jkeller@rosenbaumfirm.com added by David Rosenbaum - test@rosenbaumfirm.com as a CC'd Recipient Ip: 162.221.24.2

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https://www.rosenbauminjuryfirm.com/

Audit Trail Serial# 78d6c7fb8d267494b06be0df1bcd121b