R.H.C. Release
| Date: | December 6, 1995 |
| Pages: | 1 |
MCPHERSON LISA
[illegible patient info]
Date 12-5-95
R.H.C. RELEASE
I, the (Husband, Wife, Daughter, Son, Sister. Brother or Legal Representative), authorize HCA New Port Richey Hospital, of Florida, to release the body of
[handwritten: ] Lisa McPherson
(Name of Deceased)
to _____________________ (Funeral Home)
I certify that no member of HCA New Port Richey Hospital staff has endeavored to influence my decision in the selection of the above named funeral home.
Witness: __________________________
Signature: ________________________
Address: _________________________
Time and Date
Body Received 0400 A.M P.M. 12-6 1995
By
W. Sample for M.E.O. Dist 6
Funeral Director or Representative
FORM CH047