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Doctor’s Profile

41010
Lawrence G Blasik

Lawrence G Blasik, MD

Dermatology
Ste 3 3951 S Nova Rd, Port Orange, FL 32127
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About

Dr. Lawrence G Blasik Jr., MD, is a Dermatology specialist in Port Orange, Florida. He attended and graduated from University Of Illinois At Chicago Health Science Center in 1972, having over 47 years of diverse experience, especially in Dermatology. He is affiliated with many hospitals including Halifax Health Medical Center. Dr. Lawrence G Blasik also cooperates with other doctors and physicians in medical groups including Blue Ocean Dermatology Llc. Dr. Lawrence G Blasik accepts Medicare-approved amount as payment in full. Call (386) 256-1444 to request Dr. Lawrence G Blasik the information (Medicare information, advice, payment, ...) or simply to book an appointment.

Clinics

  • Ste 3 3951 S Nova Rd, Port Orange, FL 32127

Specializations

  • Dermatology

Education

  • Univ Of Il Coll Of Med, Chicago Il 60680, 1972
  • Dartmouth-Hitchcock M C, Dermatology; Hartford Hosp, Internal Medicine

Hospital Affiliations

  • Halifax Health Medical Center

Languages Spoken

Board Certifications

  • Dermatology; Internal Medicine

Professional Memberships

Awards & Publications

Special areas of practice expertise

Authorization Form

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    Release of Information

    Healthlynked Authorization Release of Information

    First Name:

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    I, authorize Dr. Lawrence G Blasik to release any and all healthcare information about me to my HealthLynked personal health record (PHR) for my own uses and purposes. I acknowledge that such healthcare information may include the following: x­ rays, clinical diagnosis, histories of present illnesses, immunizations, allergies, prescription drug information, laboratory results, diagnostic screening and testing, clinical procedures, medical research, clinical trials, billing, account, and insurance information.

    I acknowledge that such healthcare information may include information regarding mental health screenings and/or treatment, including psychotherapy notes; HIV/AIDS, infectious disease, sexually transmitted infection testing, screening, diagnosis, and/or treatment; genetic testing; history of domestic violence, child abuse, and/or family abuse; and, substance/ alcohol use and treatment history.

    I acknowledge that with this authorization Dr. Lawrence G Blasik may disclose any information or records (within the scope of the authorization) that Dr. Lawrence G Blasik has received about me from other healthcare practices, providers or facilities. Dr. Lawrence G Blasik may, within its discretion, withhold from disclosure any of the above information as permitted or required by law.

    Access to treatment or services may not be denied to me if I decline to sign this Authorization or revoke my Authorization. However, without this Authorization, my Dr. Lawrence G Blasik will not electronically release my healthcare informat io n to my HealthLynked PHR. I may revoke this authorization at any time. Such revocation will take effect immediately to the extent that my doctor has already acted based on this Authorization.

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    This authorization shall end upon the earliest of: a) the termination of the connection between my healthcare Dr. Lawrence G Blasik and my HealthLynked Account.

    For Authorized Representatives of Patients younger than 18 years old: This Authorization shall expire upon the earliest of: (1) the date the minor reaches the age of 18; or (2) the date HealthLynked receives written revocation from the minor, as an emancipated minor with legal authority to manage his/her own healthcare.

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    I have the right to receive a copy of this Authorization and may do so by clicking [Print] below.

    Signed on: 2021-01-26 19:28

    Name:

    Date Of Birth:

    By clicking [ACCEPT], I acknowledge and agree to the terms of this Authorization.

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