div class=ts-pagebuttonPage 1button div class=ts-image amp-img class=ts-thumb alt=Page 1: · PO Box 2800 Portland OR 97208-2800 8003682859 Tel 8003786053 Fax 1 AUTHORIZE THESE PERSONS having any records or knowledge ofme or my health: Any physician medical practitioner src=https:reader034vdocumentinreader034viewer20220502065f5954b8e3c373652f72937chtml5thumbnails1jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 2button div class=ts-image amp-img class=ts-thumb alt=Page 2: · PO Box 2800 Portland OR 97208-2800 8003682859 Tel 8003786053 Fax 1 AUTHORIZE THESE PERSONS having any records or knowledge ofme or my health: Any physician medical practitioner src=https:reader034vdocumentinreader034viewer20220502065f5954b8e3c373652f72937chtml5thumbnails2jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 3button div class=ts-image amp-img class=ts-thumb alt=Page 3: · PO Box 2800 Portland OR 97208-2800 8003682859 Tel 8003786053 Fax 1 AUTHORIZE THESE PERSONS having any records or knowledge ofme or my health: Any physician medical practitioner src=https:reader034vdocumentinreader034viewer20220502065f5954b8e3c373652f72937chtml5thumbnails3jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 4button div class=ts-image amp-img class=ts-thumb alt=Page 4: · PO Box 2800 Portland OR 97208-2800 8003682859 Tel 8003786053 Fax 1 AUTHORIZE THESE PERSONS having any records or knowledge ofme or my health: Any physician medical practitioner src=https:reader034vdocumentinreader034viewer20220502065f5954b8e3c373652f72937chtml5thumbnails4jpg width=142 height=106 layout=responsive amp-img divdivdiv class=ts-pagebuttonPage 5button div class=ts-image amp-img class=ts-thumb alt=Page 5: · PO Box 2800 Portland OR 97208-2800 8003682859 Tel 8003786053 Fax 1 AUTHORIZE THESE PERSONS having any records or knowledge ofme or my health: Any physician medical practitioner src=https:reader034vdocumentinreader034viewer20220502065f5954b8e3c373652f72937chtml5thumbnails5jpg width=142 height=106 layout=responsive amp-img divdiv