EFTA00005569-p-6.jpg

The image shows a printed document with multiple sections of text and fields filled out. The top section appears to be titled "Photo Lab Print Release," followed by a date that is partially obscured (starting with "07/30/96"). There are two blacked-out names in the first field labeled "Patient Name." Each subsequent section has similar fields such as "Photographer," "Print Number," "Medical Record," and others that are also filled out with either blacked-out information or actual data like dates and initials. The document is secured by a binder clip on the left side, indicating it's meant to be part of an organized collection or file.