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Nt, to the private health fund for the purpose of providing private health insurance in accordance with the fund’s privacy policy. I authorise my health fund to pay benefits directly to the hospital. Patient’s/ Guardian’s Signature: Date: / / Same Day Status I certify the above information is true and correct according to our records for this period of hospitalisation.The hospital authorises the fund or its agent to inspect all records applicable to the patient for the purpose of dete.

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