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Arizona Medical Board
Arizona Medical Board
Official Website of the
Arizona Medical Board
The Board's mission is to protect public health and safety.

Notice to Patients Form
"A.R.S. 32-1401(26)(ff) requires that a physician notify a patient of any financial interest in a separate diagnostic or treatment agency to which the physician is referring the patient."
The statute requires that a physician use this Board prescribed form.

The Arizona Medical Board uses Adobe Acrobat for the distribution of electronic versions of its documents. You must have the free Adobe Acrobat Reader installed on your computer to view these files.