DAVID S. VAN BEEK
11004 SW 37th Ave
Portland, OR 97219-7403
FAX: 503-245-3895   Voice: 503-245-0685
Confidential

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facsimile transmittal
To:	Toni Gress
Cancer Center Manager
Northwest Cancer Center
210 SE 136th Avenue
Vancouver, Washington 98684	Fax:	360-944-9686	
From:	David S. van Beek	Date:	Apr 23, 2003	
Re:	Elvina M. Roloff	Pages:	EIGHT	
CC:	Michael E. Roloff			

I am faxing you the information that you requested regarding my authorization to receive my mother’s medical records.
•	My letter to Dr. Smith dated March 14, 2003.
•	Certificate of Death for Elvina M. Roloff.
•	Superior Court Document, Page 1, showing my name as Son of Alvina Roloff.
•	Superior Court Document, Page 1, showing Alvina Roloff as single.
•	Invoice from DBS HEALTH RECORDS dated 3/12/2003 showing previous authorization for me to receive medical records of Elvina Roloff from Southwest Washington Medical Center.
•	Your letter to me dated April 10, 2003.

Please let me know by FAX what additional documents you need to release my mother’s medical records to me so that I may send it right away.

Thank you for your assistance.

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