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Get State Of Illinois Hysterectomy Consent Form

CONSENT TO STERILIZATION I have asked for and received information about sterilization from (Doctor/Clinic) . When I first asked for the information, I was told that the decision to be sterilized is completely up to me. I was told that I could decide not to be sterilized. If I decide not to be sterilized, my decision will not affect my right to future care or treatment. I will not lose any help or benefits from programs receiving Federal funds, such as A.F.D.C. or Medicaid that I.

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