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Get Form 8691 04

On shall be in effect for one year from this date, for records generated as a result of services occurring on or prior to this date. Revocation I understand I have a right to revoke this authorization at any time by presenting a written revocation to the Medical Record Department. I understand the revocation will not apply to: Information already released in response to this authorization My insurance company when the law provides my insurer with the right to contest a claim under my p.

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