I hereby give authorization for payment of insurance benefits to be made
directly to Younis Cardiology Assoiciates (YCA).I understand that i am
finacially responsiable for all charges whether or not they are covered
by insurance.In the event of default. I agree to pay to all costs of collection
and reasonable attorney fees.I authorize YCA to relese any medical or incidental
information that may be necessary for either medical care or in processing
applications for financial benefit.A photocopy of this agreement shall
be as valid as the agreement.