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The undersigned health care provider may revoke this authorization or change the fax number, provided that the undersigned health care provider gives LabCorp reasonable written notice. LabCorp strongly encourages all clients to physically safeguard fax machines, so that the location, access, and use of such machines comply with all HIPAA requirements.


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Partial Results Finals Only. The undersigned health care provider may revoke this authorization or change the fax number, provided that the undersigned health care provider gives LabCorp reasonable written notice.

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LabCorp strongly encourages all clients to physically safeguard fax machines, so that the location, access, and use of such machines comply with all HIPAA requirements. Provide Area Code with each fax number.

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Seperate accounts using a comma ,. Representative is usually the person filling out this form. Partial Results Finals Only. The undersigned health care provider may revoke this authorization or change the fax number, provided that the undersigned health care provider gives LabCorp reasonable written notice.
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