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�� FAIRVXEW <br />Fa`trviecv F3ealth Semices <br />Patient Financial Services <br />400 5tinson Bouteward NE <br />Minneapolis, MN 55413-2613 <br />(61� G72-672A Fa�c: (612)-672r6040 <br />F A X <br />Daee: <br />C O V E R <br />��., 1, �`�' <br />r 'A"✓� �L� ,� C��C., <br />� � <br />� '^n� <br />S ���E Tflrv� <br />Time: <br />� � � r <br />To; V I `3�hoae: <br />Fax: <br />^ <br />Prom; Phonc; <br />Re: <br />This pezsori ha�s / has not been notified/ <br />0 Lnmediate A.ction iiequesre@ CI Por Rev3ew ❑ Pleese Reply <br />Nuu,bec ofPages inclucling covex sheet� <br />7�O V <br />is being sent. <br />C] Please Call When Compleud <br />The conFidential in£ormation accompanying this transmission conta9ua protected health information under state <br />and federal �aw and is legally privileged. This informarion is intended only for the use o£ the individual or entity <br />named ahove and may be nsed only for carrying oue aeatmcnt, paymemt or other 1�ealUuare operatious. The <br />recipient oi pexson cesponsible for delivering Uus izdormation is prolubited by law £tom disclosing this information <br />without proper authorization to any otLer pazty, unless req2rired Co do so by law oi regulation Tf you ate aot the <br />inteaded recipient, you are he:eby notified that az� zeview, dissemination, distriburioa� or copying af this message <br />is strictty prohibited. Tf you have xecxived this communication in error, please destroy the materials and coatact us <br />imtuediately 6y calling the depar[me[tt nwnbet iisted ai�ove. No response indicates that the appropriate authorized <br />party received the in£ormation. rlpproved by Fafrview L.ega1, Auguse 2002. <br />. . <br />� <br />Z0:60 90aZ-TT-.IHW <br />