I hereby assign MedRetreat as my medical travel agent to collect and disseminate my personal medical documentation for the purpose of receiving healthcare abroad.<br />
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These documents will include:<br />
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Diagnostic Imaging Reports/X-Rays/Photos<br />
History &amp; Physical Exams<br />
Hospital/Doctor Charts<br />
Consultations<br />
Laboratory Reports<br />
Radiology Reports<br />
Operative Reports<br />
Discharge Summary<br />
Progress Notes<br />
Quotations/Billing Statements<br />
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I understand that MedRetreat will protect and keep this information confidential to the best of their ability.