Medical Records Authorization Letter

December 18, 2012

Ms. Shirly Mendoza
Medical Clerk
St. Joaquin Medical Center

Dear Ms. Mendoza:

I am Nathaniel Valencia of East Avenue Subd. Caloocan City.  I have been a patient of OPD Department under Dr. Henry Escudero for a 2 years.

I would like to authorize your good office to release all of requested medical information to ACCE Corporation for whatever purposes.

Thank you and more power.

Very truly yours,

Nathaniel Valencia