Decemeber 21, 1989
Di Malantakan Group of Company
292 Akasya st., Urban City
To Whom It May Concern:
I, Justine Magalpok, hereby authorize Kaonna General Hospital to release to James Kwatog Antog, my personal medical records, including all Laboratory work-ups, x-rays, and ultrasounds, and other information pertinent to my treatment while I was under the care of Kaonna General Hospital during the period of my confinement from December 1 to 4 1989.
I will use this medical information to assist in the diagnosis and treatment of my reoccurring respiratory problem. However, I do not use or disclose these details to any other purposes.