Medical Record Information Authorization Letter

April 21, 1990

Ms. Aprilyn Sanchez
St. Joseph Clinic
Balanga City, Bataan

Dear Ms. Sanchez,

I, Rico L. Herrera, hereby authorize Dr. Rodrigo C. Medina to release my personal medical information to Dr. Arnie L. Camacho.

I am writing this letter for granting access to any of my medical records such as CT scans, MRI scans and X-rays since I am under the care and treatment of Dr. Medina since February, 1990.

Sincerely yours,

(sign)
Rico L. Herrera