div class=ts-pagebutton class=gotoPage data-page=1Page 1button div class=ts-imageimg data-url=km-c368-20180308160302-chiropractor-in-middlesboro-ky-authorization-and-releasehtmlpage=1 data-page=1 class=ts-thumb lazyload alt=Page 1: KM C368-20180308160302 - Chiropractor in Middlesboro KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader033vdocumentsmxreader033viewer20220502115f5d6597a1b5c52e1802c534html5thumbnails1jpg width=140 height=200 divdivdiv class=ts-pagebutton class=gotoPage data-page=2Page 2button div class=ts-imageimg data-url=km-c368-20180308160302-chiropractor-in-middlesboro-ky-authorization-and-releasehtmlpage=2 data-page=2 class=ts-thumb lazyload alt=Page 2: KM C368-20180308160302 - Chiropractor in Middlesboro KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader033vdocumentsmxreader033viewer20220502115f5d6597a1b5c52e1802c534html5thumbnails2jpg width=140 height=200 divdivdiv class=ts-pagebutton class=gotoPage data-page=3Page 3button div class=ts-imageimg data-url=km-c368-20180308160302-chiropractor-in-middlesboro-ky-authorization-and-releasehtmlpage=3 data-page=3 class=ts-thumb lazyload alt=Page 3: KM C368-20180308160302 - Chiropractor in Middlesboro KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader033vdocumentsmxreader033viewer20220502115f5d6597a1b5c52e1802c534html5thumbnails3jpg width=140 height=200 divdivdiv class=ts-pagebutton class=gotoPage data-page=4Page 4button div class=ts-imageimg data-url=km-c368-20180308160302-chiropractor-in-middlesboro-ky-authorization-and-releasehtmlpage=4 data-page=4 class=ts-thumb lazyload alt=Page 4: KM C368-20180308160302 - Chiropractor in Middlesboro KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader033vdocumentsmxreader033viewer20220502115f5d6597a1b5c52e1802c534html5thumbnails4jpg width=140 height=200 divdivdiv class=ts-pagebutton class=gotoPage data-page=5Page 5button div class=ts-imageimg data-url=km-c368-20180308160302-chiropractor-in-middlesboro-ky-authorization-and-releasehtmlpage=5 data-page=5 class=ts-thumb lazyload alt=Page 5: KM C368-20180308160302 - Chiropractor in Middlesboro KY · AUTHORIZATION AND RELEASE: I authorize payment of insurance benefits directly to the chiropractor or chiropractic office loading=lazy src=data:imagegifbase64iVBORw0KGgoAAAANSUhEUgAAAAIAAAACCAQAAADYv8WvAAAAD0lEQVR42mP8X8AwAgiABKBAv+vAXklAAAAAElFTkSuQmCC data-src=https:reader033vdocumentsmxreader033viewer20220502115f5d6597a1b5c52e1802c534html5thumbnails5jpg width=140 height=200 divdiv
