Prolo Hawaii

Liza Maniquis-Smigel, MD LLC

Physical Medicine & Rehabilitation

Spine, Sports & Electrodiagnostic Medicine

Prolotherapy

AFFIRMATION AGREEMENT AND AUTHORIZATION
AGREEMENT TO RELEASE CONFIDENTIAL INFORMATION
MEDICARE AUTHORIZATION (Medicare patients only)
PRESCRIPTION POLICY (Please type in your initial below)
NOTICE OF PRIVACY PRACTICE (NPP)
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