During this period, she proceeded to the kitchen table and filled out and completed the SSA Consent for Release of Information, HIPAA Authorization, and the Authorization to Collect and Disclose information form. She, however, declined to sign the Optional Authorization form. …show more content…
The Insured confirmed her mailing address and physical address at 19001 Abajo Drive, Monterey Park, CA 91754. She confirmed her date of birth to be December 26, 1960, and stated for the record her name to be Mary Kathleen Genovia, AKA: Mary Kathleen Rodriguez Genovia as indicated within her driver’s license. She confirmed her Social Security number 564-80-8041, and she was born in Bellflower, California. She is a U.S. Citizen, and her telephone number is (323)