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A~ac]~-nen~ A <br /> <br />Notification of Intent to Serve <br /> <br />Notification of Intent to Serve will be sent to MHS, at (216) 361-8646 to the attention of Sylvia <br />Millin, upon obtaining a Release of Irfformafion from a client that has been accepted for services <br />by PROVIDER under this Agreement. If a client refuses to provide a Release of Information, <br />data without specific client ~dentifying information will'be faxed instead. The information to be <br />faxed is as follows: <br /> <br />2. <br />3. <br />4. <br /> <br />Name <br />Address / Phone # <br />Date of Iucident <br />Copy ofKelease Oflu~ormation <br /> <br />Page 5 of 6 <br /> <br /> <br />