※Office Hours: 
-National Taiwan University Hsin-Chu Hospital：
Monday-Friday: 8:00 A.M.-5:00 P.M. Saturday: 8:00 A.M.-11:30 AM.

-National Taiwan University BioMedical Park Hospital：
Monday-Friday: 8:00 A.M.-5:00 P.M. 

-National Taiwan University BioMedical Park Hospital Chu-Tung Campus：
Monday-Friday: 8:00 A.M.-5:00 P.M.

The undersigned hereby authorizes National Taiwan University Hospital Hsin-Chu Branch to release my medical information described above. 
_________________ Signature of Patient or Patient's Legal Representative
_________________ Signature of Patient's Representative