To Release To: thesecondopinion
Medical Director, Howard B. Kleckner, M.D.
1200 Gough Street, Suite #500, San Francisco, CA. 94109
Intended Use: 2nd Opinion Tumor Board. Effective immediately and valid for one year. I may revoke this authorization in writing at any time. No other use will be made of this information without prior authorization from me unless such use is specifically required/permitted by law.