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Ents to be released are described or listed as: The records are required for the specific purpose of: I understand that my authorization will remain effective from the date of my signature until , and that the information will be handled confidentially in compliance with all applicable federal laws. I understand that I may see the information that is to be sent, and that I may revoke the authorization at any time by written, dated communication. I have read and understand the nature of this re.

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