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Get Hfs 2189 R 7 06

To the best of my knowledge and belief the individual to be sterilized is at least 21 years old and appears mentally competent. He/She knowingly and voluntarily requested to be sterilized and appears to understand the nature and consequence of the procedure. Instructions for use of alternative final paragraphs Use the first paragraph below except in the case of premature delivery or emergency abdominal surgery where the sterilization is performed.

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